Editorial
Increase and change in the profile of poisonings in the elderly
Incremento y cambio en el perfil de las intoxicaciones en ancianos
a Departamento de Medicina Física y Farmacología, Facultad de Ciencias de la Salud, Universidad de La Laguna, Tenerife, Spain
b Fundación Española de Toxicología Clínica (FETOC), Spain
c Unidad de Toxicología Clínica, Servicio de Medicina Interna, Consorcio Hospital General Universitario, Valencia, Spain
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Poisoned elderly individuals have longer emergency department stays and are more often admitted to the intensive care unit. According to a multivariate analysis, ICU admission was not a result of the individual’s age, but rather specifically due to suicidal ideation or the use of metformin.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> In addition, mortality in their series (2.16%) was much higher than that of other Spanish multicenter series on acute poisonings, in which mortality ranged from 0.2% to 1.4%.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Another recent study which compared individuals over 65 years of age with adults and individuals younger than 17 years of age found a somewhat higher incidence of poisoning (8.9% vs. the 6.1% found by Puiguriguer et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>), a significantly greater use of antidotes, and a higher percentage of hospital admissions and intensive care unit admissions in the elderly age range.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Though this study also had a long study period (2013–2019), it only recorded data on one day per month and as such, the sample of elderly individuals analyzed was only 97 patients. Although from a methods point of view, this is an approach that we have frequently used in multicenter studies on poisoned individuals in order to achieve a high degree of adherence from centers and investigators,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,8</span></a> the work by Puiguriguer et al. has the added value of being a continuous, daily registry of cases over nine years (2011–2019).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6,9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition to containing data on metformin, lithium, and caustic products, digoxin poisonings are noteworthy in both works.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,10</span></a> In our opinion, the use of antidigoxin antibodies is not very widespread, given the assumption of a theoretically high price and short period before the expiration date. Nevertheless, to our knowledge, this price does not take into account the additional costs of long stays in emergency departments, short-stay units, or hospital wards which occur when they are not used and the spontaneous remission of digoxinemia is waited for.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand, for the group of nervous system depressant drugs (benzodiazepines and opiates),<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> you have to keep in mind the imminent interruption of cannabinoid use in the elderly. As a recent Canadian communication stated, the banalization of cannabis and its legalization in some countries has produced an exponential increase in its use among the elderly, especially outside of its therapeutic indications.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The work published in this issue of Revista Clínica Española, in our opinion, leads us to three conclusions: as the authors indicate, acute or chronic poisonings in elderly patients should rank several places higher on the list of etiological causes of patients with altered levels of consciousness, shock, or clinical conditions that are difficult to explain.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Faced with an unexplainable, disjointed clinical condition, let's consider that it could be an intoxication and possibly an attempt at self-harm sooner.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Second, it seems necessary to increase the training of internal medicine and family and community medicine physicians on clinical toxicology.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> To do so, it is essential to create specific clinical toxicology units for teaching and for treating patients as well as for clinical consultation purposes. There must be at least one in each autonomous community in order to create multidisciplinary teams with proven experience and training. In this regard, the implementation of specific training areas included in Spain’s Law on Classification of Healthcare Professions (LOPS, for its initials in Spanish) would be an important opportunity for defining and launching them<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> as well as the inclusion of existing clinical toxicology units in the Spanish National Health System’s Centers, Departments, and Reference Units (CESUR, for its initials in Spanish) catalog.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Third, it is necessary to modify our concept of an elderly individual, given the foreseen delay in the retirement age. Indeed, the precipice of 65 years will be officially modified and activities of daily living, including work, and obviously acute poisonings will change along with it.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,19</span></a> Furthermore, the new WHO definitions of older adults change the concept of old age. It includes individuals older than 60 years with the following age ranges: youngest-old (60–74 years), middle-old (75–90 years), and oldest old (older than 90 years).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The work by Puiguriguer et al. analyzes patients in 5-year age groups, which provides us with an epidemiological basis that will serve as reference for future progress analyses.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Lastly, we are not divorced from the reality of COVID-19 and the second wave we are living through, which has affected any healthcare study done previously. The impact of the confinement period during the first state of alarm decreed in March 2020 in terms of psychological, psychiatric, and toxicological consequences is currently being studied.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21,22</span></a> Therefore, it is possible that its repercussion on the elderly may have been different than what is indicated in the works mentioned herein.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,10</span></a> We hope that the new COVID-19 reality does not substantially impact the elderly, who are the most valued asset of a developed, just, and grateful society.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Burillo-Putze G, Climent-Díaz B. 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| 2023 March | 6 | 3 | 9 |
| 2021 September | 1 | 0 | 1 |
| 2021 June | 1 | 0 | 1 |
