Umsetzung und Schwierigkeiten bei Tropftherapien – der ältere Glaukompatient im Fokus

Zusammenfassung

Der Erfolg einer medikamentösen Glaukomtherapie hängt entscheidend von der Mitwirkung des Patienten ab. Die „Adhärenz“, früher auch „Compliance“ genannt, bezeichnet hierbei die Bereitschaft und Fähigkeit, den ärztlichen Therapieempfehlungen im Alltag zu folgen. Adhärenz objektiv zu erfassen, unterliegt erheblichen Fehlerquellen, da man i. d. R. auf subjektive Aussagen und ärztliche Einschätzungen angewiesen ist. In der Literatur streuen die Werte der Adhärenz zwischen 5 und 95 %. Allgemeine Gründe für eine verminderte Adhärenz können z. B. mit dem Medikament selbst, mit dem Patienten, mit dessen Umfeld und mit seiner Versorgungssituation assoziiert sein. Das Alter der Patienten kann alle genannten Faktoren verändern, insbesondere aber die patientenassoziierten. Hierzu gehören Einschränkungen motorischer und geistiger Fähigkeiten, Demenzerkrankungen und Depressionen. Bei motorischer bzw. taktiler Einschränkung wird mit Einmalophthiolen im Vergleich zu Tropfflaschen eine schlechtere Trefferquote erzielt, was bei älteren Patienten unbedingt bedacht werden sollte. Die verordnete Applikationsfrequenz hat einen signifikanten Einfluss auf die Therapietreue. Die nur 1-mal täglich zu applizierenden Prostaglandinanaloga oder Kombinationspräparate verbessern bspw. die Bereitschaft, eine chronische Therapie durchzuführen. Vielversprechende Impulse zur Verbesserung der Adhärenz bietet der elektronische Markt, der z. B. durch Smartphones die Möglichkeit eröffnet, durch akustische Signale an die Tropfapplikation zu erinnern. Insgesamt scheint eine supportive und über die Krankheit informierende Umgebung der Patienten, sei es durch intelligente Geräte, Familienmitglieder, medizinische Betreuung oder Selbsthilfegruppen, wesentlich die Adhärenz und damit den Therapieerfolg – auch bei schwieriger Ausgangssituation der Patienten – zu steigern.

Abstract

In order to treat glaucoma with medication successfully, the patient needs to participate actively in the process. “Adherence”, formerly “compliance”, describes the willingness and capacity to follow the prescribed regimen every day. It is not trivial to measure adherence and persistence, as this quite often relies on self reports by the patient or speculations by the physician. Hence, the overall reported adherence may vary from 5 to 95 %. In general, the following categories have been defined for reduced adherence: medication-related factors, patient-related factors, environmental factors and social factors. Age has been found to intensify or modify many of these factors. Older adults often face various challenges, due to motor disabilities, reduced visual acuity or impaired cognitive capabilities. In patients with movement disorders or tactile limitations, the target area can be reached more successfully with standard eye drop bottles than with single-use dose units. This should be considered if antiglaucoma eye drops are prescribed in the elderly. Frequency of application is a main factor influencing adherence. Monotherapy – as provided with prostaglandins – or drops with a fixed combination have proven to support adherence significantly. A significant boost for self-monitoring activities is initiated by the growing market of electronic devices, like smartphones. For instance, they can provide acoustic alarms as reminders to apply the eye drops. It is evident that any external support or disease-related information by family members, the medical practitioners, support groups or even electronic devices may improve adherence and persistence, even in patients with severe impairments.

Schlüsselwörter

Adhärenz - Compliance - Glaukom - medikamentöse Therapie - Alter

Key words

adherence - compliance - glaucoma - medication - age

• Literatur

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