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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Epidemiological research on acute poisonings has traditionally focused on adult patients<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> and&#44; in individual cases&#44; on children&#44; in whom prevention measures are the main objective&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> As Puiguriguer et al&#46; indicate in their work&#44; both in Spain and in our European and American healthcare setting&#44; few works have addressed poisonings in the population over 65 years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> With a longer-lived and fortunately more numerous Spanish population&#44; their article is relevant and invites us to analyze this phenomenon from a clinical and healthcare management perspective&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A notable finding in this work is the annual increase in poisonings among the elderly and&#44; in particular&#44; that poisonings with suicidal intent increase by 2&#46;5&#37; in each five-year age group&#46; Poisoned elderly individuals have longer emergency department stays and are more often admitted to the intensive care unit&#46; According to a multivariate analysis&#44; ICU admission was not a result of the individual&#8217;s age&#44; but rather specifically due to suicidal ideation or the use of metformin&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> In addition&#44; mortality in their series &#40;2&#46;16&#37;&#41; was much higher than that of other Spanish multicenter series on acute poisonings&#44; in which mortality ranged from 0&#46;2&#37; to 1&#46;4&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;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 &#40;8&#46;9&#37; vs&#46; the 6&#46;1&#37; found by Puiguriguer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#41;&#44; a significantly greater use of antidotes&#44; and a higher percentage of hospital admissions and intensive care unit admissions in the elderly age range&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Though this study also had a long study period &#40;2013&#8211;2019&#41;&#44; it only recorded data on one day per month and as such&#44; the sample of elderly individuals analyzed was only 97 patients&#46; Although from a methods point of view&#44; 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&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;8</span></a> the work by Puiguriguer et al&#46; has the added value of being a continuous&#44; daily registry of cases over nine years &#40;2011&#8211;2019&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6&#44;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition to containing data on metformin&#44; lithium&#44; and caustic products&#44; digoxin poisonings are noteworthy in both works&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a> In our opinion&#44; the use of antidigoxin antibodies is not very widespread&#44; given the assumption of a theoretically high price and short period before the expiration date&#46; Nevertheless&#44; to our knowledge&#44; this price does not take into account the additional costs of long stays in emergency departments&#44; short-stay units&#44; or hospital wards which occur when they are not used and the spontaneous remission of digoxinemia is waited for&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand&#44; for the group of nervous system depressant drugs &#40;benzodiazepines and opiates&#41;&#44;<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&#46; As a recent Canadian communication stated&#44; the banalization of cannabis and its legalization in some countries has produced an exponential increase in its use among the elderly&#44; especially outside of its therapeutic indications&#46;<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 Cl&#237;nica Espa&#241;ola&#44; in our opinion&#44; leads us to three conclusions&#58; as the authors indicate&#44; 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&#44; shock&#44; or clinical conditions that are difficult to explain&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Faced with an unexplainable&#44; disjointed clinical condition&#44; let&#39;s consider that it could be an intoxication and possibly an attempt at self-harm sooner&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Second&#44; it seems necessary to increase the training of internal medicine and family and community medicine physicians on clinical toxicology&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> To do so&#44; it is essential to create specific clinical toxicology units for teaching and for treating patients as well as for clinical consultation purposes&#46; There must be at least one in each autonomous community in order to create multidisciplinary teams with proven experience and training&#46; In this regard&#44; the implementation of specific training areas included in Spain&#8217;s Law on Classification of Healthcare Professions &#40;LOPS&#44; for its initials in Spanish&#41; 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&#8217;s Centers&#44; Departments&#44; and Reference Units &#40;CESUR&#44; for its initials in Spanish&#41; catalog&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Third&#44; it is necessary to modify our concept of an elderly individual&#44; given the foreseen delay in the retirement age&#46; Indeed&#44; the precipice of 65 years will be officially modified and activities of daily living&#44; including work&#44; and obviously acute poisonings will change along with it&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> Furthermore&#44; the new WHO definitions of older adults change the concept of old age&#46; It includes individuals older than 60 years with the following age ranges&#58; youngest-old &#40;60&#8211;74 years&#41;&#44; middle-old &#40;75&#8211;90 years&#41;&#44; and oldest old &#40;older than 90 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The work by Puiguriguer et al&#46; analyzes patients in 5-year age groups&#44; which provides us with an epidemiological basis that will serve as reference for future progress analyses&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Lastly&#44; we are not divorced from the reality of COVID-19 and the second wave we are living through&#44; which has affected any healthcare study done previously&#46; The impact of the confinement period during the first state of alarm decreed in March 2020 in terms of psychological&#44; psychiatric&#44; and toxicological consequences is currently being studied&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> Therefore&#44; it is possible that its repercussion on the elderly may have been different than what is indicated in the works mentioned herein&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a> We hope that the new COVID-19 reality does not substantially impact the elderly&#44; who are the most valued asset of a developed&#44; just&#44; and grateful society&#46;</p></span>"
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October 2021 Increase and change in the profile of poisonings in the elderly
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Vol. 221. Issue 8.
Pages 473-475 (October 2021)
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Vol. 221. Issue 8.
Pages 473-475 (October 2021)
Editorial
DOI: 10.1016/j.rceng.2020.11.008
Increase and change in the profile of poisonings in the elderly
Incremento y cambio en el perfil de las intoxicaciones en ancianos
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G. Burillo-Putzea,b,
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gburillo@ull.edu.es

Corresponding author.
, B. Climent-Díazb,c
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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