山西省老年住院患者多重用药现况及对患者生命质量的影响

目的探讨本地区老年住院患者多重用药现状及对患者生命质量的影响。方法随机抽取2013年5⁷月在该院内科治疗的老年患者436例,利用自制的结构式问卷和EQ-5D生命质量量表对入选患者多重用药现状和生命质量进行评价。结果入选患者中平均日常服药数量(5.16±1.49)种,最多17种;其中371例(85.09%)服用西药及其制剂;331例(75.92%)服用中药及其制剂;57例(13.07%)存在潜在性不适当用药。70岁及以上的患者疾病种类、服药种类、服药总数均明显高于657月在该院内科治疗的老年患者436例,利用自制的结构式问卷和EQ-5D生命质量量表对入选患者多重用药现状和生命质量进行评价。结果入选患者中平均日常服药数量(5.16±1.49)种,最多17种;其中371例(85.09%)服用西药及其制剂;331例(75.92%)服用中药及其制剂;57例(13.07%)存在潜在性不适当用药。70岁及以上的患者疾病种类、服药种类、服药总数均明显高于65⁶9岁患者(P<0.05)。不同用药数量、服用潜在不适当药物数量、用药依从性、药物不良反应的患者间生命质量评分差异有统计学意义(P<0.01,P<0.05)。用药数量、潜在性不适当用药数量和用药依从性是患者生命质量的主要影响因素,其中患者用药数量是最大影响因素。结论多病共存、消费能力增强造成了老年住院患者多重用药的广泛存在,且随着患者年龄增大用药数量明显增多;用药数量是影响老年住院患者生命质量的最主要因素。     

老年患者多重用药研究进展

<正>增龄导致机体内环境改变,肝肾功能下降,影响药物在体内的药动学和药效学特征,造成药物在体内蓄积,导致药物不良反应(ADR)的发生率增高。老年人群常有多种慢性疾病共存,同时服用多种药物,多重用药现象非常普遍,增加了老年患者发生ADR的风险,降低患者的依从性,同时也消耗大量卫生资源。本文就近年来有关老年患者多重用药的研究进展做一综述。1老年患者多重用药研究现状多重用药属于老年综合征之一,已成为现代老年医学研究     

高干病房老年住院患者用药分析

我们对首都医科大学宣武医院综合9病区2002年2月至2002年4月住院病历进行统计，探索我院临床老年患者用药中的规律和问题，为临床安全用药、提高老年患者的治愈率提供依据。     

石家庄社区老年多重用药患者生命质量及其影响因素

目的 了解社区老年多重用药患者用药情况与生命质量现状及其影响因素.方法 依据五维健康(EQ-5D)量表和自制问卷对石家庄市416例社区多重用药的老年非住院患者用药情况和生存质量进行横断面调查.结果 该社区老年患者平均用药4.9种,其中处方药3.1种,非处方药及保健品1.8种,潜在性不适当药物发生率为14.7％,EQ-5D的均值为0.74,EQ-VAS均值71.34,老年患者的生命质量与用药数量、服用潜在性不适当药物及用药依从性显著相关(P＜0.05).结论 随着用药数量的增加,老年患者进行药物治疗的风险增加,生命质量受到较大影响.     

老年人多重用药引起的不良药物相互作用三例

老年人作为一个特殊群体,其各脏器功能减退,多病共存,同时不可避免地存在多重用药的问题.多药联合治疗可能增加药物相互作用的机会,不良的药物-药物相互作用(ADI)严重影响老人健康,甚至可造成残疾和死亡.我们在此报告3个典型的ADI病例以提高大家对由多重用药引起的不良药物相互作用的认识.     

老年患者多重用药处方精简干预临床效果的Meta分析

目的系统评价处方精简干预对老年多重用药患者临床结局的影响。方法检索数据库公开发表有关老年多重用药患者处方精简干预及相关结局的文献。根据纳入排除标准进行筛选,采用Review Manager 5.3软件,利用I~2衡量文献研究内容的异质性,运用固定效应模型或随机效应模型合并分析处方精简干预对老年多重用药患者临床结局的影响。结果本研究最终纳入18篇随机对照研究(RCT),文献总体质量较好。Meta分析显示,处方精简干预不能降低老年多重用药患者全因死亡率[OR=0.86, 95%CI(0.67～1.09)]。不同干预方式比较:特异性处方精简干预在一定程度上降低全因死亡率[OR=0.68, 95%CI(0.51～0.92);P0.05]。随访时间长短比较:随访时间较长(6个月)相较于随访时间较短(≤6个月)的处方精简干预在降低全因死亡率方面具有一定优势[OR=0.58, 95%CI(0.39～0.86)vsOR=1.02, 95%CI(0.76～1.36);P0.05]。不同年龄段比较:对不同年龄段患者进行精简干预,全因死亡率没有变化[OR=0.63, 95%CI(0.40～1.02)vsOR=0.95, 95%CI(0.72～1.25);P0.05]。认知状态比较:对不同认知状态患者进行精简干预,全因死亡率不发生改变[OR=0.63, 95%CI(0.37～1.07)vsOR=0.93, 95%CI(0.71～1.22);P0.05]。处方精简干预不能减少跌倒患者的数量[OR=0.98, 95%CI(0.74～1.27)],但可以显著降低年人均跌倒次数[MD=-0.11, 95%CI(-0.21～-0.02)],缩短患者住院时长[MD=-0.49, 95%CI(-0.76～-0.22)]。结论现有数据分析表明,处方精简干预不能降低老年多重用药患者的全因死亡率,特异性或长时间随访的处方精简干预在降低患者全因死亡率方面有一定优势;处方精简干预不能减少跌倒患者人数但可以减少患者跌倒次数;处方精简干预有缩短住院时长的趋势。特异性处方精简干预在减少不适当的多重用药方面是安全可行的。     

老年人多重用药及评价工具的研究进展

我国老龄化问题日益严峻,这对老年人相关疾病的诊治提出了新的挑战.老年综合评估是老年医学的核心技术,是对老年患者的躯体功能、精神心理、社会环境、生活质量及多重用药等多方面进行的全面个体化评估.其中多重用药是老年人中一种常见的老年综合征,会增加老年人药物不良反应的发生风险,对老年人多重用药采取行之有效的评估和干预已成为亟待...     

住院老年慢性肾脏病患者肾脏不适当用药调查及影响因素分析

目的 分析住院老年慢性肾脏病(CKD)患者肾脏不适当用药(RIM)的发生情况及相关影响因素,为临床肾脏合理用药提供依据。方法 回顾性分析2020年1月至2020年12月某大型综合三甲医院748例住院老年CKD患者的临床资料。利用国内外药品说明书、专家共识、用药手册以及Micromedex数据库等药学工具评估RIM的发生情况。采用SPSS 22.0统计软件进行数据分析。采用多因素logistic回归分析影响RIM的危险因素。结果 本研究住院老年CKD患者RIM发生率为50.27%(376/748),共发生RIM 739次。RIM发生频次排名前5的药物类别分别为抗微生物药[46.01%(340/739)]、内分泌系统药[11.77%(87/739)]、泌尿系统药[11.50%(85/739)]、心血管系统药[9.88%(73/739)]及镇痛药[7.31%(54/739)],排名前3的药物品种分别为螺内酯[9.47%(70/739)]、左氧氟沙星[9.34%(69/739)]及头孢哌酮钠舒巴坦钠[7.04%(52/739)]。主要不适当用药情况为肾功能下降时,未调整相关药物剂量。多因素lo...     

老年人药物不良反应及用药原则

老年人由于药物代谢动力学的改变，神经系统、内分泌系统、各种器官功能及代偿等逐渐衰退，机体耐受性降低，对药物的敏感性发生变化，因此发病率也随之上升，药物不良反应发生率增高。据统计表明，50～60岁患者的药物不良反应发生率为14．4％，61～70岁为15．7％，71～81岁为18．3％，80岁以上为24．0％，据国家药品监督管理局不良     

老年人药物重整的应用效果分析

目的应用药物重整方法对老年住院患者不合理用药进行调整。方法入选2012年6月至2013年10月北京协和医院老年示范病房所有≥65岁的老年住院患者208例,年龄(76.0±6.8)岁。由药师参与每日老年科病房的查房,医师与药师合作,对老年住院患者进行药物重整。结果208例患者有多种慢性状况(MCC)(8.0±3.8)种,195例入院时有长期用药,用药(4.8±3.5)种,多重用药占48.1%;女性用药种类显著多于男性[(5.3±3.7)vs(4.3±3.2)种,P=0.035]。最常使用药物种类依次与下列慢性病有关:心脑血管病(78.8%)、消化系统问题(51.4%)、前列腺疾病(30.8%)、骨质疏松(24.5%)、糖尿病(24.5%)。入院时发现不合理用药占63.9%,药物不良反应13.9%,最常见潜在导致不良反应的药物为中枢神经和心血管系统药物。≥85岁患者多重用药(χ~2=4.78,P=0.03)及不合理用药情况(χ~2=3.91,P=0.048)显著高于85岁患者。63.9%(133/208)老年患者调整了用药。结论老年科住院患者慢性病及老年问题多,多重用药发生率高,需要与药师合作通过药物重整发现问题并及时干预。     

基于2019年版Beers标准评价老年住院患者潜在不适当用药的价值

目的 基于Beers标准(2019年版)对老年住院患者潜在不适当用药(PIM)情况进行评价,为促进老年人临床合理用药提供参考.方法 回顾性分析昆明医科大学附属延安医院2019年5月至11月出院的728例老年住院患者的用药情况.根据Beers标准(2019年版)对老年住院患者的PIM情况进行评估.采用SPSS 23.0统...     

Polypharmacy and potentially inappropriate medications among elderly patients in the geriatric department at a single-center in China: A retrospective cross-sectional study

The aging of the population has become a worldwide concern, especially in China. Polypharmacy and potentially inappropriate medications (PIMs) are prominent issues in elderly patients. Therefore, the aim of this study was to investigate the prevalence of polypharmacy and PIMs in older inpatients and further to explore the factors associated with PIM use.A retrospective, single-center, cross-sectional study was conducted. A total of 1200 inpatients aged 65 years or older admitted from January 2015 to December 2015 were included. The prevalence of polypharmacy (5–9 medications) and hyperpolypharmacy (10 or more medications) was calculated. The 2019 American Geriatric Society Beers criteria were applied to assess PIMs use. Multivariate logistic regression was used to determine the independent factors of PIM use, while zero-inflated negative binomial regression was performed to evaluate the relationship between polypharmacy and PIM use.The median age of the study population was 76 years (interquartile range = 71–81). The median number of medications was 9 (interquartile range = 7–12). 91.58% of the patients took 5 or more medications simultaneously, and 30.08% of the patients were subjected to one or more PIMs. Spironolactone, furosemide, and zopiclone were the top 3 most frequently encountered PIMs. Hyperpolypharmacy and older age were identified as independent factors associated with PIM use. The risk of PIMs rises with the number of medications prescribed.Polypharmacy and PIM use were common in our study, and the risk of PIM use correlated with an increase in the number of medications already prescribed.     

Multidisciplinary Team Deprescribing Intervention for Polypharmacy in Elderly Orthopedic Inpatients: A Propensity Score-matched Analysis of a Retrospective Cohort Study

Objective This study evaluated the effectiveness of a multidisciplinary team deprescribing intervention to reduce polypharmacy and potentially inappropriate medications (PIMs) in elderly orthopedic inpatients. Methods In this single-center retrospective observational study, orthopedic inpatients ≥75 years old and prescribed ≥6 different medications were enrolled as participants. Interventions comprised multidisciplinary team-led polypharmacy screening and suggestions regarding deprescribing any unnecessary medications during hospital stays. The primary outcome was reduction in the mean number of regular medicines and PIMs. Secondary outcomes included falls, delirium, and other adverse events during hospitalization as well as emergency department visits or unplanned hospital admissions within six months after discharge. Results After propensity score matching, 184 patients (intervention group, n=92; control group, n=92) were included in the analysis. The mean patient age was 83 years old. The mean number of prescribed medications and PIMs at admission were similar in both groups. The mean change in the number of regular medicines was -1.4 [standard deviation (SD), 2.3] in the intervention group and +0.2 (SD, 1.8) in the control group (p<0.001). The mean change in the number of PIMs was -0.5 (SD, 0.9) in the intervention group and +0.1 (SD, 0.8) in the control group (p<0.001). In-hospital adverse events other than falls and delirium were significantly less common in the deprescribing intervention group than in the control group. Conclusion Deprescribing intervention by our multidisciplinary team seems to have been effective in reducing the number of prescribed medicines and PIMs in elderly orthopedic inpatients, with some accompanying reduction in certain adverse events.     

The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people

OBJECTIVES: To determine whether a medication review by a specialized team would promote regimen changes in elders taking multiple medications and to measure the effect of regimen changes on monthly cost and functioning. DESIGN: A randomized-controlled trial. SETTING: Health center ambulatory clinic. PARTICIPANTS: Community-dwelling older adults taking five or more medications were assessed at baseline and 6 weeks. A medication-change intervention group of 57 elders was compared with a control group of 76 elder adults. INTERVENTION: The primary intervention was a comprehensive review and recommended modification of a patient's medication regimen. Changes were endorsed by each patient's primary physician and discussed with each patient. MEASUREMENTS: Measures were the Timed Manual Performance Test, Physical Performance Test, Functional Reach Assessment, subtests from the Wechsler Adult Intelligence Scale, a modified Randt Memory Test, the Center for Epidemiological Studies-Depression Scale, the Self-Rating Anxiety Scale, and the Rand 36-item Health Survey 1.0. Comorbidity was determined using the International Classification of Diseases, Ninth Revision, Clinical Modification. Medication usage was determined using brown bag review. RESULTS: Intervention subjects decreased their medications by an average of 1.5 drugs. No differences in functioning were observed between groups. Intervention subjects saved an average $26.92 per month in wholesale medication costs; control subjects saved $6.75 per month (P<.006). CONCLUSION: Although the intervention significantly reduced the medications taken and monthly cost, most patients were resistant to reducing medications to the recommended level. Further study is needed to understand patient resistance to reducing adverse polypharmacy and to devise better strategies for addressing this important problem in geriatric health. Greater focus on prescriber behavior is recommended.     

Association between falls and high-risk medication use in hospitalized Asian elderly patients

Aim:   Most studies looking at the relation between medication use and fall among the hospitalized elderly patients, were done in Western countries. So, a study was planned to investigate the role of medications in causing falls in hospitalized Asian elderly patients.
Methods:   Case note review was done for all patients age 65 years and above, who fell at least once during their hospital stay over a 12-month period. Information obtained from the case notes included: (i) demographic information; (ii) Modified Morse Fall scale; (iii) circumstances and time of fall; and (iv) medication use. From the hospital admission database, an age- and sex-matched control group was selected for comparison.
Results:   Over the 12-month study period, 298 patients met the study criteria. Average age of the patients was 75.8 years, 60.4% were male and 84.9% were Chinese. Multivariate analysis showed that fallers had longer lengths of stay and were more likely to have a history of falls. Fallers were also more likely to be taking hypnotics, cough preparations and anti-platelets, but less likely to be taking paracetamol. Fallers were on fewer medications.
Conclusion:   Elderly hospitalized patients on hypnotic drugs, cough preparations and anti-platelets were more likely to fall. Appropriate usage of analgesics, especially paracetamol, to relieve pain may reduce falls.     

社区老年人潜在不适当用药与衰弱的相关性

目的 使用中国标准筛查社区老年患者潜在不适当用药(PIM),并研究PIM、神经系统PIM与衰弱的相关性.方法 招募2018年12月至2019年3月北京某社区的老年人,记录其一般情况、患病情况及用药情况.使用埃德蒙德衰弱量表评估衰弱情况.根据《中国老年人潜在不适当用药目录》筛查PIM.根据查尔森共病指数判断共病严重情况....