北京市社区老年人潜在不适当用药的调查分析

目的 调查北京市社区老年人潜在不适当用药(potentially inappropriate medication,PIM)现状.方法 采用自我报告方式,收集北京市社区215名老年人用药信息,根据2019版美国老年人PIM标准(Beers criteria for PIM use in older adults,Beers标准)和中国老年人潜在不适当用药判断标准(中国PIM标准)评价并做描述性分析.结果 根据2019版Beers标准发现66人(30.7%)存在84例次PIM,其中中枢神经系统药物(36例次)、血液系统药物(14例次)、内分泌系统药物(11例次)导致的PIM最多;采用中国PIM标准发现53人(24.7%)存在73例次PIM,前三位分别为:中枢神经系统药物(31例次),血液系统药物(17例次),解热、镇痛、抗炎与抗风湿药(17例次).结论 社区老年人PIM发生率较高,特别是中枢神经系统和血液系统用药需要引起关注.Beers标准和中国PIM标准可相互补充,且需不断更新完善.     

某院门急诊老年患者潜在不适当用药的评价分析

目的 使用Beers标准(2019版)对某院门急诊老年患者潜在不适当用药(PIM)情况进行系统分析,为促进患者用药安全提供依据.方法 回顾性抽取某院2020年第四季度门急诊处方,对65岁及以上的老年患者用药情况进行统计分析,以Beers标准(2019版)为评判依据,评价老年患者PIM情况.结果 共收集该院2020年第四...     

基于Beers标准(2019版)评价河北省多种慢性病共存老年心力衰竭住院患者的潜在不适当用药

目的 基于Beers标准(2019版)对河北地区多种慢性病共存老年心力衰竭(简称心衰)住院患者的潜在不适当用药(PIM)进行调查,并结合各疾病专科诊疗指南进行深入分析,探讨其相关危险因素,为促进多种慢性病共存老年人群临床合理用药提供参考。方法 2022年1月随机从河北省4家医疗机构信息系统中各抽取50例老年心衰住院患者的电子病历资料。根据纳入与排除标准,最终纳入135例符合标准的患者。基于Beers标准(2019版)对老年心衰住院患者的PIM情况进行评估,结合疾病诊疗指南深入用药分析评价,给出用药建议。采用多因素Logistic回归分析老年心衰住院患者发生PIM的影响因素。结果 不同年龄、罹患疾病种类的老年心衰住院患者PIM发生率比较,差异均无统计学意义(P>0.05);不同性别、用药种类、肾小球滤过率(GFR)的老年心衰住院患者PIM发生率比较,差异均有统计学意义(P<0.05)。按PIM发生频率高低排序前3位依次为利尿剂、螺内酯、苯二氮类镇静催眠药物。38例患者存在53例次PIM,排名前3的药物分别为苯二氮类镇静催眠药物、地高辛和抗精神病药物。24例患者存在26例次PI...     

潜在不适当用药对老年人不良健康结局影响的系统评价

目的 明确潜在不适当用药对老年人不良健康结局的影响,为预防不良健康结局提供依据.方法 检索PubMed、The Cochrane Library、Web of Science、EMBASE、中国生物医学文献数据库、中国知网和万方数据库,搜集建库至2019年2月关于潜在不适当用药对老年人不良健康结局影响的文献,采用RevMan 5.3软件进行分析.结果 共纳入33项队列研究,结果显示潜在不适当用药对药物不良反应、再次入院率有影响(RR=1.69,95%CI=1.28~2.23,P<0.001;RR=1.47,95%CI=1.30~ 1.66,P<0.001),但不会增加死亡率(RR=1.02,95%CI=0.98~ 1.07,P=0.310).结论 潜在不适当用药是老年人发生药物不良反应/药物不良事件和再次入院的危险因素,增加了社会经济负担,耗费了医疗资源.     

老年人多重用药问题思考及老年人用药策略建议

人口老龄化给现行的医疗流程和体系带来了新的挑战。老年人普遍存在的多种疾病共存和多重用药问题,降低了患者对治疗的依从性、不仅药物不良反应增加,同时医保费用超支。该文描述了人口老龄化背景下老年患者多重用药的现状,分析其影响因素,结合临床经验提出了解决策略建议,呼吁老年医学工作者在完善老年综合评估基础上,理性地制定老年患者用药策略,并随病情发展变化及时调整,实现智慧用药,全面提高老年人生活质量。     

老年住院患者潜在不恰当用药的影响因素分析

目的研究老年住院患者潜在不恰当用药发生率及影响因素。方法随机抽取符合纳入标准的陕西省人民医院住院患者699例,使用2015版Beers标准评价病例,采用频率统计方法、χ2检验中的独立性检验及多因素Logistic回归分析进行统计描述及推断。结果 (1)老年住院患者潜在不恰当用药发生率为79.5%。(2)联合用药数量多、医保报销比例高的老年住院患者更容易发生潜在不恰当用药,内科病房相对外科病房的老年住院患者更容易发生潜在不恰当用药。结论老年住院患者潜在不恰当用药发生率高,联合用药数量、医保类型、出院科室为其影响因素。     

老年人临床用药现状与合理用药

我国已经处于老龄化社会,老年人的用药具有人群特殊性。该文总结老年人用药现状以及国家药物政策,分析老年人用药存在的问题,国家对老年人用药的扶持政策,探讨老年人合理用药的方法原则。     

老年人多重用药与认知障碍关系的研究进展

随着我国人口老龄化进程的加快,慢性病已经成为影响老年人健康不容忽视的问题。而老年人往往同时患有多种慢性疾病,为了改善疾病状况,老年人常服用多种药物进行治疗即多重用药。认知障碍是老年人常见的神经系统退行性病变,目前多项研究表明,多重用药与认知障碍存在相关性。该文就老年人多重用药与认知障碍的关系作一综述,以期使医生对相关性问题有更深入的认识,为减少老年人不合理用药及认知障碍发生提供参考依据。     

基于Beers标准和STOPP/START标准评价老年消化道疾病的潜在不适当用药

目的了解老年患者消化道疾病的潜在不恰当用药,为老年患者消化道疾病的临床用药提供借鉴。方法提取在老年医学科住院的285例患者病历,依据Beers标准和STOPP/START标准,对消化道疾病存在的潜在不恰当用药情况进行筛查。结果依据Beers标准,285例患者病历中有61例(21%)存在潜在不适当用药,共计85项。按照STOPP标准,285例患者病历中23例(8%)筛查出潜在不适当用药,共计39项;按照START标准,筛查出16例(6%)患者病历存在处方遗漏情况,共计16项; 50例(18%)患者存在Beers标准和STOPP/START标准未包括的潜在不适当用药(PIMs);影响老年消化道疾病患者发生PIMs的因素包括:年龄、疾病种类、住院时间、用药种类、日常生活能力量表评分(ADL)。结论老年患者消化道疾病存在潜在不恰当用药,易导致PIMs的影响因素较多,使用Beers标准和STOPP/START标准对老年消化道疾病患者的用药进行评估,能有效降低PIMs发生,提高老年消化道疾病诊疗的医疗质量。     

Beers criteria for potentially inappropriate medication use in older adults

Nurses can decrease the risk of adverse drug problems with medication review and prompt interventions. The Beers Criteria lists medications to avoid using among elderly clients. The origin of the Beers Criteria, its 2002 modification, and application in acute care settings are explained.     

Factors influencing the use of potentially inappropriate medication in older patients in Slovakia

Background: Although increasing attention has been given to the evaluation of use of potentially inappropriate medication in the older European Union (EU) member countries, information on this topic from Central and Eastern Europe is scarce. Objectives: The aims of the present study were: to identify risk factors enhancing the probability of use of potentially inappropriate medication in hospitalized older patients under the conditions of the Slovak healthcare system and to compare our results with previously published European studies. Methods: The evaluation was performed in 600 patients aged ≥65 years, hospitalized in a general hospital between 1 December 2003 and 31 March 2005. To identify the use of potentially inappropriate medication, the Beers 2003 criteria were applied. Particular socio‐demographic and clinical characteristics, as well as comorbid medical conditions were evaluated among possible factors enhancing the probability of use of potentially inappropriate medication. Results: At least one potentially inappropriate medication was prescribed to 126 (21%) of 600 patients. Multivariate analysis identified polypharmacy [odds ratio (OR) 2·38; 95% confidence interval (CI): 1·50–3·79], depression (OR 2·03; 95% CI: 1·08–3·82), immobilization (OR 1·87; 95% CI: 1·16–3·00) and heart failure (OR 1·73; 95% CI: 1·13–2·64) as factors associated with an increased risk of use of inappropriate medication. In contrast, patients aged ≥75 years had a lower risk of being prescribed potentially inappropriate medication (OR 0·58; 95% CI: 0·39–0·88). Conclusions: Polypharmacy, immobilization, heart failure and depression were documented as predictors of use of potentially inappropriate medication. In depressive patients, drugs other than antidepressants contributed to the extensive use of potentially inappropriate medication. The observed prevalence of use of potentially inappropriate medication in older hospitalized Slovak patients was lower than the prevalence previously documented in Poland and the Czech Republic, but higher than in Croatia and Turkey. The identified risk factors were consistent with previous findings from other parts of Europe.     

Patterns of potentially inappropriate medication use across three cohorts of older Medicaid recipients

BACKGROUND: Potentially inappropriate medication use is a serious quality concern, especially when it occurs in more vulnerable older adults or for extended durations. OBJECTIVE: To characterize patterns of inappropriate medication use and duration among 3 cohorts with differing health status. METHODS: We identified unconditionally inappropriate drug use, using Beers 1997 criteria, among 3185 older Kansas Medicaid beneficiaries. Claims from May 2000 to April 2001 provided data for 3 cohorts: nursing facility (NF) residents, recipients of home- and community-based services through the Frail Elderly (FE) program, and persons with neither NF/FE care (Ambulatory). Duration, categorized as short-term (< or = 1 month's supply), extended (> 1-9 mo), or chronic (> 9-12 mo), was determined for each drug and cohort. Drug-disease associations were explored. RESULTS: Any inappropriate medication use occurred in 21%, 48%, and 38% of Ambulatory, FE, and NF cohorts, respectively. Inappropriate analgesics, antihistamines, antidepressants, muscle relaxants, and oxybutynin were most common, but prevalence and duration varied by cohort. Short-term analgesic and antihistamine use was common. FE cohort members had the highest use rates for all drugs. The NF cohort had less antidepressant and muscle relaxant use. Drug-disease associations were noted for amitriptyline use in diabetes mellitus, propoxyphene use in musculoskeletal and upper gastrointestinal conditions, and muscle relaxant use in musculoskeletal conditions. CONCLUSIONS: Cross-sectional, one-year prevalence figures are comprised of both short- and long-term use that varies by drug and cohort. NF residence is associated with reduced use of drugs scrutinized during mandated medication review. Relevant diseases are associated with specific inappropriate prescribing. Future efforts should target extended and chronic duration of use and persons at highest risk for adverse effects, including recipients of home- and community-based care.