Halte à « l’overdose » médicamenteuse chez les personnes âgées ! 1422

Dr Moussayer khadija, 2 y.

- Science - Society - Health -

3.3 min read.

Des prescriptions de médicaments trop souvent inadéquates et potentiellement dangereuses pour les personnes âgées ! Plus on vieillit, plus on risque de souffrir de maladies chroniques, notamment auto-immunes, nécessitant des traitements au long cours. Il est alors important de bénéficier d’un usage optimum des médicaments. Ce qui est loin d’être le cas si l’on se réfère à de nombreuses études internationales, en Europe comme en Amérique, qui montrent que : plus de 25 % des prescriptions médicales des personnes de plus de 65 ans sont potentiellement inappropriées (contenant au moins un médicament inadéquat), 40 % des prescriptions des plus de 75 ans sont inappropriées, et que la majorité de ces derniers sont soumis à une polymédication (plus de 5 médicaments) parfois délétère. Pire encore, l’enquête EPI-PHARE publiée en 2023 en France a dévoilé que la prévalence de ces prescriptions préjudiciables était de 33% supérieure chez les résidents en EHPAD par rapport aux personnes âgées vivant à domicile ! QU’EST-CE QU’UN MEDICAMENT POTENTIELLEMENT INAPPROPRIE ? Se définit comme médicament potentiellement inapproprié (MPI) celui pour lequel les risques sont supérieurs aux bénéfices. Ce phénomène a plusieurs raisons : la tendance du malade à attendre une solution thérapeutique à tout trouble et à être mécontent de sortir du médecin sans ordonnance ; la fragmentation des soins sans bonne coordination, quand le patient reçoit des médicaments de différents médecins ; le désir des médecins de bien guérir tous les troubles par la prescription la plus complète, trop même car créatrice d'autres déséquilibres… Résultat de tout cela : un tiers des hospitalisations des séniors dans les pays développés est lié directement ou indirectement à un mauvais usage thérapeutique ! Ce constat global est également valable au Maroc. UNE MOINDRE TOLÉRANCE AUX MÉDICAMENTS AVEC L’ÂGE Avec le vieillissement, des changements se produisent dans le corps rendant la personne âgée (PA) plus sujette aux effets secondaires des médicaments. La quantité totale d’eau de l’organisme diminue alors que la quantité de tissu adipeux augmente. Ainsi, les médicaments solubles dans l’eau deviennent plus concentrés et ceux solubles dans la graisse s’accumulent davantage dans cette dernière. De plus, les reins sont moins capables d’excréter les médicaments dans l’urine et le foie est moins capable de décomposer de nombreux médicaments. De ce fait, les médicaments restent en plus grande quantité et plus longtemps dans l’organisme que chez un adulte de 30/40 ans et leur passage est plus agressif dans le cerveau. Ainsi, le paracétamol, un antalgique utilisé contre la douleur et/ou la fièvre, s’élimine deux fois plus lentement, le diazepam (valium), un tranquillisant, quatre fois plus lentement : il faut 80 heures - 3 jours ! - pour éliminer la moitié de la dose donnée de ce dernier. Avec une prise quotidienne, une thérapeutique peut alors s’accumuler jusqu’à l’intoxication. DES EFFETS SECONDAIRES AUX CONSEQUENCES PARFOIS DESASTREUSES ! Fatigue excessive, diminution de l’appétit, perte de poids, vertiges, malaise... Les signes d’un accident médicamenteux sont assez banals en général. Plusieurs catégories de médicaments sont plus susceptibles d'entraîner des effets indésirables, en particulier certains antalgiques, anticoagulants, antihypertenseurs, antiparkinsoniens, diurétiques, hypoglycémiants et psychotropes. La sur-médication (plus de 5 médicaments) est souvent nocive car on ne maîtrise pas bien les interactions entre les différentes molécules. Mal employés, certains médicaments sont responsables de véritables pathologies comme la dépression, la dénutrition (par baisse de l'appétit et du goût), les chutes, l’état de somnolence, la confusion aigüe ou encore les neuropathies. Un usage inconsidéré d’antihypertenseurs peut aussi provoquer des baisses trop importantes de la tension, source alors d’étourdissements, de vertige et des chutes, aux conséquences lourdes : la fracture du col du fémur est ainsi souvent à l’origine de la perte d'autonomie et même de la mort. L’ABSENCE D’UN MEDECIN « REFERENT » AU MAROC DOMMAGEABLE A LA COHERENCE THERAPEUTIQUE La situation au Maroc est complexe. Jusqu’à présent, beaucoup de personnes ne bénéficiaient pas des traitements nécessaires faute de moyens financiers. La généralisation de l’assurance maladie a beaucoup amélioré l’accès aux soins. Pour ceux qui ont déjà des assurances, la problématique est souvent identique à celle décrite dans les pays les plus développés, sinon parfois pire ! Les séniors pratiquent encore trop un nomadisme médical, les amenant à se faire soigner à la fois ou successivement par plusieurs médecins en fonction de leurs pathologies. D’où une tendance à la sur-médication, alors que, comme en Europe, ils devraient avoir un seul médecin référent, le médecin de « famille », qui les prend en charge globalement en coordonnant l’ensemble des soins et en décidant des thérapeutiques. Cela peut être le médecin généraliste, le spécialiste d’une pathologie, le gériatre ou le spécialiste en médecine interne. Ce dernier est d’ailleurs reconnu comme le plus apte à prendre en charge les situations les plus complexes et polypathologiques, de par sa compétence transversale et donc globale. La règle d’or en gériatrie est de se concentrer sur la ou les 2 ou 3 pathologies principales mais de ne pas chercher à tout prix à médicamenter les autres écarts à la normalité. Le dernier point à souligner est enfin la bonne observance des traitements par les malades car c’est souvent leur défaillance qui pose problèmes : donc, respectez les prescriptions médicales, les recommandations des notices d’emploi et ne vous livrez pas à l’automédication ! Dr Moussayer Khadija الدكتورة خديجة موسيار Spécialiste en médecine interne et en Gériatrie POUR EN SAVOIR PLUS ; – Halte à l’overdose pour les personnes âgées ! Que Choisir Santé 28/01/2015 https://www.quechoisir.org/action-ufc-que-choisir-medicaments-halte-a-l-overdose-pour-les-personnes-agees-n14033/ – 30% des hospitalisations chez les personnes âgées liées à une médication inappropriée, Communiqué Université catholique de Louvain (UCL) 30 septembre 2016 https://cdn.uclouvain.be/public/Exports%20reddot/ac-arec/documents/30-09-2016_cp_A_Spinewine_medication_inappropriee_pers_agees.pdf - Catégories de médicaments qui méritent une vigilance chez le patient âgé – Manuel MSD https://www.msdmanuals.com/fr/professional/g%C3%A9riatrie/traitement-m%C3%A9dicamenteux-chez-les-personnes-%C3%A2g%C3%A9es/cat%C3%A9gories-de-m%C3%A9dicaments-qui-m%C3%A9ritent-une-vigilance-chez-le-patient-%C3%A2g% C3%A9 - Solène Drusch , Mahmoud Zureik , Marie Herr Potentially inappropriate medications and polypharmacy in the older population : A nationwide cross-sectional study in France in 2019 , Elsevier Therapies September–October 2023, Pages https://doi.org/10.1016/j.therap.2023.02.001

Dr Moussayer khadija

Dr MOUSSAYER KHADIJA الدكتورة خديجة موسيار Spécialiste en médecine interne et en Gériatrie en libéral à Casablanca. Présidente de l’Alliance Maladies Rares Maroc (AMRM) et de l’association marocaine des maladies auto-immunes et systémiques (AMMAIS), Vice-présidente du Groupe de l’Auto-Immunité Marocain (GEAIM)

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THE ENCHIRIDION - I 2136

Bluwr X Commons: Epictetus, 2 y.

1.1 min read.

There are things which are within our power, and there are things which are beyond our power. Within our power are opinion, aim, desire, aversion, and, in one word, whatever affairs are our own. Beyond our power are body, property, reputation, office, and, in one word, whatever are not properly our own affairs. Now the things within our power are by nature free, unrestricted, unhindered; but those beyond our power are weak, dependent, restricted, alien. Remember, then, that if you attribute freedom to things by nature dependent and take what belongs to others for your own, you will be hindered, you will lament, you will be disturbed, you will find fault both with gods and men. But if you take for your own only that which is your own and view what belongs to others just as it really is, then no one will ever compel you, no one will restrict you; you will find fault with no one, you will accuse no one, you will do nothing against your will; no one will hurt you, you will not have an enemy, nor will you suffer any harm. Aiming, therefore, at such great things, remember that you must not allow yourself any inclination, however slight, toward the attainment of the others; but that you must entirely quit some of them, and for the present postpone the rest. But if you would have these, and possess power and wealth likewise, you may miss the latter in seeking the former; and you will certainly fail of that by which alone happiness and freedom are procured. Seek at once, therefore, to be able to say to every unpleasing semblance, “You are but a semblance and by no means the real thing.” And then examine it by those rules which you have; and first and chiefly by this: whether it concerns the things which are within our own power or those which are not; and if it concerns anything beyond our power, be prepared to say that it is nothing to you.

THE ADVENTURES OF TOM SAWYER - PREFACE 2239

Bluwr X Commons: Mark Twain, 2 y.

- Short Stories -

0.6 min read.

Most of the adventures recorded in this book really occurred; one or two were experiences of my own, the rest those of boys who were schoolmates of mine. Huck Finn is drawn from life; Tom Sawyer also, but not from an individual—he is a combination of the characteristics of three boys whom I knew, and therefore belongs to the composite order of architecture. The odd superstitions touched upon were all prevalent among children and slaves in the West at the period of this story—that is to say, thirty or forty years ago. Although my book is intended mainly for the entertainment of boys and girls, I hope it will not be shunned by men and women on that account, for part of my plan has been to try to pleasantly remind adults of what they once were themselves, and of how they felt and thought and talked, and what queer enterprises they sometimes engaged in. THE AUTHOR. HARTFORD, 1876.

THE MEDITATIONS - Book I.[1/3] 2301

Bluwr X Commons: Marcus Aurelius, 2 y.

3.7 min read.

1. I learned from my grandfather, Verus, to use good manners, and to put restraint on anger. 2. In the famous memory of my father I had a pattern of modesty and manliness. 3. Of my mother I learned to be pious and generous; to keep myself not only from evil deeds, but even from evil thoughts; and to live with a simplicity which is far from customary among the rich. 4. I owe it to my great-grandfather that I did not attend public lectures and discussions, but had good and able teachers at home; and I owe him also the knowledge that for things of this nature a man should count no expense too great. 5. My tutor taught me not to favour either green or blue at the chariot races, nor, in the contests of gladiators, to be a supporter either of light or heavy armed. He taught me also to endure labour; not to need many things; to serve myself without troubling others; not to intermeddle in the affairs of others, and not easily to listen to slanders against them. 6. Of Diognetus I had the lesson not to busy myself about vain things; not to credit the great professions of such as pretend to work wonders, or of sorcerers about their charms, and their expelling of Demons and the like; not to keep quails (for fighting or divination), nor to run after such things; to suffer freedom of speech in others, and to apply myself heartily to philosophy. Him also I must thank for my hearing first Bacchius, then Tandasis and Marcianus; that I wrote dialogues in my youth, and took a liking to the philosopher’s pallet and skins, and to the other things which, by the Grecian discipline, belong to that profession. 7. To Rusticus I owe my first apprehensions that my nature needed reform and cure; and that I did not fall into the ambition of the common Sophists, either by composing speculative writings or by declaiming harangues of exhortation in public; further, that I never strove to be admired by ostentation of great patience in an ascetic life, or by display of activity and application; that I gave over the study of rhetoric, poetry, and the graces of language; and that I did not pace my house in my senatorial robes, or practise any similar affectation. I observed also the simplicity of style in his letters, particularly in that which he wrote to my mother from Sinuessa. I learned from him to be easily appeased, and to be readily reconciled with those who had displeased me or given cause of offence, so soon as they inclined to make their peace; to read with care; not to rest satisfied with a slight and superficial knowledge; nor quickly to assent to great talkers. I have him to thank that I met with the discourses of Epictetus, which he furnished me from his own library. 8. From Apollonius I learned true liberty, and tenacity of purpose; to regard nothing else, even in the smallest degree, but reason always; and always to remain unaltered in the agonies of pain, in the losses of children, or in long diseases. He afforded me a living example of how the same man can, upon occasion, be most yielding and most inflexible. He was patient in exposition; and, as might well be seen, esteemed his fine skill and ability in teaching others the principles of philosophy as the least of his endowments. It was from him that I learned how to receive from friends what are thought favours without seeming humbled by the giver or insensible to the gift. 9. Sextus was my pattern of a benign temper, and his family the model of a household governed by true paternal affection, and a steadfast purpose of living according to nature. Here I could learn to be grave without affectation, to observe sagaciously the several dispositions and inclinations of my friends, to tolerate the ignorant and those who follow current opinions without examination. His conversation showed how a man may accommodate himself to all men and to all companies; for though companionship with him was sweeter and more pleasing than any sort of flattery, yet he was at the same time highly respected and reverenced. No man was ever more happy than he in comprehending, finding out, and arranging in exact order the great maxims necessary for the conduct of life. His example taught me to suppress even the least appearance of anger or any other passion; but still, with all this perfect tranquillity, to possess the tenderest and most affectionate heart; to be apt to approve others yet without noise; to have much learning and little ostentation. 10. I learned from Alexander the Grammarian to avoid censuring others, to refrain from flouting them for a barbarism, solecism, or any false pronunciation. Rather was I dexterously to pronounce the words rightly in my answer, confining approval or objection to the matter itself, and avoiding discussion of the expression, or to use some other form of courteous suggestion. 11. Fronto made me sensible how much of envy, deceit and hypocrisy surrounds princes; and that generally those whom we account nobly born have somehow less natural affection. 12. I learned from Alexander the Platonist not often nor without great necessity to say, or write to any man in a letter, that I am not at leisure; nor thus, under pretext of urgent affairs, to make a practice of excusing myself from the duties which, according to our various ties, we owe to those with whom we live. 13. Of Catulus I learned not to condemn any friend’s expostulation even though it were unjust, but to try to recall him to his former disposition; to stint no praise in speaking of my masters, as is recounted of Domitius and Athenodorus; and to love my children with true affection. 14. Of Severus, my brother, I learned to love my kinsmen, to love truth, to love justice. Through him I came to know Thrasea, Helvidius, Cato, Dion, and Brutus. He gave me my first conception of a Commonwealth founded upon equitable laws and administered with equality of right; and of a Monarchy whose chief concern is the freedom of its subjects. Of him I learned likewise a constant and harmonious devotion to Philosophy; to be ready to do good, to be generous with all my heart. He taught me to be of good hope and trustful of the affection of my friends. I observed in him candour in declaring what he condemned in the conduct of others; and so frank and open was his behaviour, that his friends might easily see without the trouble of conjecture what he liked or disliked.