Pharmaceuticals released from senior residences: occurrence and risk evaluation

Abstract

One of the main pursuits, yet most difficult, in monitoring studies is to identify the sources of environmental pollution. In this study, we have identified health-care facilities from south European countries as an important source of pharmaceuticals in the environment. We have estimated that compounds consumed in by the elderly and released from effluents of senior residences can reach river waters at a concentration higher than 0.01 μg/L, which is the European Medicines Agency (EMA) threshold for risk evaluation of pharmaceuticals in surface waters. This study has been based on five health institutions in Portugal, Spain, and France, with 52 to 130 beds. We have compiled the pharmaceuticals dispensed on a daily base and calculated the consumption rates. From 54.9 to 1801 g of pharmaceuticals are consumed daily, with laxatives, analgesics, antiepileptics, antibiotics, and antidiabetic agents being the main drug families administered. According to excretion rates, dilution in the sewerage system, and elimination in wastewater treatment plants, macrogol, metformin, paracetamol, acetylcysteine, amoxicillin, and gabapentin, among others, are expected to reach river waters. Finally, we discuss the risk management actions related to the discharge of pharmaceuticals from senior residences to surface waters.

Pharmaceutical Residues in Senior Residences Wastewaters: High Loads, Emerging Risks

“…Senior residences have a configuration of typically 50–150 individuals and provide lodging, meal services and health assistance. Following medical prescription patterns, the total amount of pharmaceuticals consumed in conventional senior residences range from 1 to 400 g day −1 , and concomitantly hundreds of milligrams of drugs of different therapeutic use are excreted [ 12 ]. Wastewaters from senior residences, as in most hospitals, are discharged untreated to the sewage grid and enter into the WWTPs.…”

“…As many pharmaceuticals are not eliminated with the conventional activated sludge treatment, these compounds are discharged to receiving waters, posing environmental risks [ 5 ]. Considering that senior residences have become a popular and well-accepted option for the health-care system, especially in southern Europe due mainly to the mild climate, these establishments have become a hot-spot for pharmaceutical discharge [ 12 ].…”

Towards an innovative combined process coupling biodegradation and photo‐oxidation for the removal of pharmaceutical residues

“…Pharmaceuticals have become one of most important class of emerging organic micropollutants because they are persistent and bioactive compounds that could affect aquatic organisms even at very low concentrations 1,3,6,7 . The main source of pharmaceutical pollution in the environment is wastewater treatment plant (WWTP) effluents, composed mainly of domestic and industrial wastewaters, but also receiving hospital or retirement home effluents which are released untreated to the sewage grid 1,3,8–10 . Owing to their intrinsic characteristics of high polarity and stability, most PhCs are not removed by conventional activated sludge (CAS) in WWTP 2,3,5,7 .…”

“…Three pharmaceuticals widely investigated in the literature – IBU, DCF and CBZ – were first selected as model molecules with high, moderate and low biodegradation potentials, respectively. Then, four additional molecules among those most frequently found in wastewater from retirement homes 10 also were added: furosemide (FUR), levetiracetam (LEV), amylmetacresol (AMY) and paracetamol (PAR). To demonstrate the feasibility of this hybrid system, the present work was divided into two distinct steps.…”

“…1,3,6,7 The main source of pharmaceutical pollution in the environment is wastewater treatment plant (WWTP) effluents, composed mainly of domestic and industrial wastewaters, but also receiving hospital or retirement home effluents which are released untreated to the sewage grid. 1,3,[8][9][10] Owing to their intrinsic characteristics of high polarity and stability, most PhCs are not removed by conventional activated sludge (CAS) in WWTP. 2,3,5,7 Consequently they are released continuously into water bodies, and their increasing occurrence has become a major environmental and human health concern.…”