Potentially inappropriate medications in older individuals with diabetes: A population-based study in Quebec,Canada

AimTo study the population-based prevalence of potentially inappropriate medication (PIM) among older individuals with diabetes, and to identify factors associated with their use.MethodsWe used the Quebec Integrated Chronic Disease Surveillance System (QICDSS) database to conduct a population-based cohort study of individuals with diabetes ≥66 years between April 1st, 2014 and March 31st, 2015. PIMs were defined according to the 2015 Beers Criteria. Factors associated with PIM use were identified using robust Poisson regression models. Risk ratios (RR) and 99% confidence intervals (99%CI) were calculated.ResultsMore than half (56%) of the 286,962 older individuals with diabetes used at least one PIM over a year. Benzodiazepines (41%), proton pump inhibitors (27%) and endocrine medication (mainly glibenclamide) (25%) were the most common PIMs used. Factors associated with PIM use included female sex (RR: 1.17; 99%CI: 1.16–1.18), and comorbidities such as schizophrenia (1.48; 1.45–1.51), anxiety disorders (1.34; 1.33–1.35) and Alzheimer's disease (1.14; 1.13–1.25). Risks of using PIMs increased both with increasing comorbidities and number of medications.ConclusionPIM use is highly prevalent among older individuals with diabetes. Interventions to promote optimal medication use should particularly target individuals with comorbidities and polypharmacy who are most vulnerable to adverse drug events.     

American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults

The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults is widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a regular cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2023 update, an interprofessional expert panel reviewed the evidence published since the last update (2019) and based on a structured assessment process approved a number of important changes including the addition of new criteria, modification of existing criteria, and formatting changes to enhance usability. The criteria are intended to be applied to adults 65 years old and older in all ambulatory, acute, and institutionalized settings of care, except hospice and end-of-life care settings. Although the AGS Beers Criteria® may be used internationally, it is specifically designed for use in the United States and there may be additional considerations for certain drugs in specific countries. Whenever and wherever used, the AGS Beers Criteria® should be applied thoughtfully and in a manner that supports, rather than replaces, shared clinical decision-making.     

老年患者潜在不适当用药与跌倒的相关性

目的探讨老年患者潜在不适当用药(PIM)与跌倒的关系。方法采取横断面研究,纳入2017年1月至2017年12月首都医科大学附属复兴医院综合科住院患者280例(≥65岁)。根据入院前6个月有无跌倒史分为2组:跌倒组(n=36)和非跌倒组(n=244)。收集患者一般资料,测试握力、步速等临床资料。采用查尔森共病指数(CCI)评估疾病,微型营养评估简表(MNA-SF)筛查患者营养状态。采用SPSS 23.0软件进行统计分析,依据数据类型采用t检验、非参数检验或χ2检验。正态分布资料采用Pearson相关分析,非正态分布资料采用Spearman相关分析。采用logistic回归分析筛选出独立的危险因素。结果入选患者的PIM使用率为69.3%(194/280)。精神类PIM使用率为36.1%(101/280),心血管PIM使用率为22. 9%(64/280),其他类PIM使用率为8.9%(25/280)。跌倒组中服用精神类PIM患者比例显著高于非跌倒组(58. 3%vs 32. 8%,P=0. 005)。相关分析显示,跌倒与骨质疏松(r=0. 238,P 0. 001)、焦虑抑郁(r=0. 170,P 0. 004)、服用≥5种口服药(r=0. 123,P=0. 040)、服用精神类PIM (r=0. 178,P=0. 004)和女性(r=0. 230,P=0. 006)呈显著正相关,与握力(r=-0. 146,P=0. 015)和步速(r=-0. 134,P=0. 025)呈显著负相关。logistic回归分析显示,跌倒与骨质疏松(OR=3. 973,95%CI1. 759～8. 973,P=0. 001)和服用精神类PIM(OR=2. 415,95%CI 1. 141～5. 114,P=0. 021)相关。结论老年患者服用精神类PIM与跌倒相关。临床医师应加强合理用药,避免精神类PIM特别是A级(优先警示)药物使用,减少老年患者跌倒风险。     

潜在不适当用药与衰弱老年人不良结局的相关分析

目的评估潜在不适当用药(PIM)与衰弱老年人不良结局的相关性。方法入选2015年1月至2017年12月首都医科大学附属复兴医院综合科老年衰弱患者226例进行研究,根据美国老年医学会Beers标准(2015版)将患者纳入PIM组(n=169)和非PIM组(n=57),比较2组患者日常生活能力(ADL)、认知功能和查尔森共病指数(CCI)等老年综合评估情况。随访截止2018年12月,不良结局终点事件包括非计划再入院和全因死亡。应用SPSS 23.0统计软件对数据进行分析。Cox回归分析PIM与衰弱患者临床不良结局的相关性,Kaplan-Meier生存曲线分析2组患者生存率的差异。结果 PIM检出率为74.8%(169/226),PIM药物中雷贝拉唑占52.7%(89/169),艾司唑仑占42.6%(72/169)。PIM组较非PIM组患者口服药种类和疾病数明显增多,差异有统计学意义(P0.05)。Cox回归分析结果表明PIM(HR=1.425,95%CI 1.005～2.021;P=0.047)、年龄(HR=1.047,95%CI 1.013～1.083;P=0.007)和CCI(HR=1.095,95%CI 1.014～1.182;P=0.021)与不良结局相关。Kaplan-Meier分析表明PIM组与非PIM组衰弱老年患者生存率差异有统计学意义(P=0.033)。结论 PIM与衰弱老年人不良结局相关,应加强衰弱筛查及临床合理用药。     

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.     

Effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients discharged from acute care hospitals

AimTo comparatively investigate the effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients after hospital discharge.MethodsOur series consisted of 733 patients aged ≥65 consecutively enrolled in a multicenter observational longitudinal study. PIMs were defined on the basis of updated versions of Beers and STOPP criteria. The occurrence of functional decline was defined as the loss of independency in at least 1 basic activity of daily living (BADL) from discharge through 3-month follow-up visit.ResultsAfter adjusting for several potential confounders, hyperpolypharmacy (OR = 2.20; 95%CI = 1.11–4.37) and Beers violations (OR = 1.99; 95%CI = 1.17–3.49) were significantly associated with functional decline, while STOPP (OR = 1.10; 95%CI = 0.64–1.88) and combined Beers + STOPP violations (OR = 1.72; 95%CI = 0.97–3.05) were not. In logistic regression models simultaneously including both hyperpolypharmacy and PIMs, hyperpolypharmacy was always associated with functional decline (OR = 1.98; 95%CI = 1.0–3.97 in the model including Beers violations; OR = 2.19; 95%CI = 1.11–4.35 in the model including STOPP violations; OR = 2.04; 95%CI = 1.02–4.06 in the model including combined Beers and STOPP violations). Beers violations (OR = 1.89; 95%CI = 1.09–3.28) also remained significantly associated with the outcome in this latter analysis, but not STOPP or combined Beers and STOPP violations.ConclusionsHyperpolypharmacy, and to a lesser extent Beers violations predict functional decline in older patients discharged from acute care hospitals, whilst STOPP criteria are no longer associated with the outcome after adjusting for potential confounders. Hyperpolypharmacy is associated with functional decline independent of PIMs.     

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...     

老年住院患者潜在不适当用药与内在能力下降相关性研究

【摘 要】 目的 探讨老年住院患者潜在不适当用药(PIM)与内在能力（IC）下降的相关性。方法 回顾性分析2022年1月至6月首都医科大学附属复兴医院老年住院患者215例,根据中国老年人 PIM 目录确定PIM,将病例分为 PIM 组125例和非PIM组90例,记录患者共病情况、口服药种类,评估IC等指标。应用SPSS 23.0 统计软件对数据进行处理,组间比较采用独立样本t检验、非参数检验或χ2检验,Spearman 相关分析PIM与IC下降的相关性,多因素 logistic回归分析PIM的相关危险因素。结果 入组病例年龄60～109（84±7）岁,男性134例（占62.3%）,IC评分2.0（1.0,3.0）分,79.7%（200/215）病例存在IC下降,其中运动能力下降75.8%（163/215）,IC下降≥3分占40.0%（86/215）。口服药种类0～17种/人,人均6（3,8）种,服用≥5种口服药者占63.3%（136/215）,PIM使用率58.1%（125/215）。查尔森共病指数（CCI）7（6,9）。ADL评分6.0（4.0,6.0）分, IADL6.0（3.0,8.0）分。与非PIM组比较,PIM组病例年龄、疾病严重程度、失眠、便秘、呛咳、口服药种类明显增多（P＜0.05）,IC评分明显下降（P＜0.001）,IC5项标准中运动能力下降最为明显（P＜0.05）。相关分析结果显示：PIM与年龄（r=0.167,P=0.014）、IC评分（r=0.205,P=0.002）、多重用药（r=0.468,P＜0.001）、CCI（r=0.214,P=0.002）呈显著正相关。多因素 logistic 回归分析显示：在调整年龄、性别、疾病严重程度、多重用药因素后,IC评分下降仍与PIM相关（OR=1.567）。结论 老年住院患者PIM与IC下降相关,应该加强对IC下降的老年住院患者PIM筛查,减少PIM使用。