老年人不宜使用的药物

不适当药物的使用是导致老年人发病和死亡的一个重要原因.文章介绍了国际上广泛应用的两个老年人用药指南.Beers标准介绍了48种药物在老年人中应避免使用或限量使用和20种老年人特定病症不宜使用药物的理由及危害等级.加拿大标准介绍了38种药物在老年人中应避免使用,并对老年人不适当处方行为提出了替代治疗方案.推广两个指南的应...     

老年人潜在不适当用药Beers标准2015新修订版介绍

正距2012年老年人潜在不适当用药Beers标准修订版发布后仅3年,美国老年医学会(American geriatrics society,AGS)于2015年10月8日再次发布对Beers标准更新[1-2]。2012年Beers标准修订版包括5个部分内容,分别为:老年患者潜在不适当用药,老年患者疾病状态相关的潜在不适当用药,老年患者慎用药物,2008版Beers标准基础上增加     

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...     

高龄住院患者潜在不适当用药调查及影响因素分析

目的 联合Beers标准和老年人不适当处方筛查工具(STOPP)标准对高龄住院患者潜在不适当用药(PIM)发生率进行调查,并探讨其影响因素.方法 回顾性分析2015年1月至2020年12月在解放军总医院第二医学中心住院且年龄≥80岁的患者1023例.应用Beers标准(2019版)和STOPP标准(2014版)筛查PI...     

老年人药物不良反应390例分析

探讨老年人药物不良反应的发生特点和影响因素。方法采用回顾性统计研究方法,对成都市各市级医院2000-01/2006-06报告的390份老年人药物不良反应（Adverse drug reactions in the elderly,ADRE）监测报告进行统计、分析处理。结果在统计的390份ADRE报表中,抗微生物药物116例,占29.74%,排第1位;单一用药143例,占36.67%,而联合用药247例,占63.33%;占前5位的不良反应分别是皮肤及其附件损害、消化系统反应、心血管系统反应、神经系统反应和泌尿系统反应。结论在对老年人进行用药时应合理使用抗微生物药物,减少不必要的联合用药,并应加强对各易损系统的观察和保护。     

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。     

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     

老年人用药现状及评价方式

<正>研究~([1~3])表明65岁以上老年人人均患有7种疾病,老年人常常多病共存,导致多重用药,同时老年人的药效学和药动学及其不良反应存在很大的差异,很可能存在潜在性不恰当用药(PIM)。PIM亦属于多重用药范畴,PIM可能会引起药物不良反应(ADR),导致药物不良事件(ADEs)的发生,使死亡率、医     

要重视老年人药物不良反应事件的监测

21世纪全球进入老龄化阶段,从1950年到1980年,全球老龄人口所占的比重增加了50％以上,预计到2025年这一比例还会再增加一半以上。我国大部分城市也已进入高速发展的老龄化阶段。2004年底,中国60岁以上老龄人口达1．43亿,占世界老龄人口的1／5,预计到2050年,中国老龄人口将达4亿,占人口总数的11．2％。社会的快速老龄化和老龄人口数量的急剧增长给老年医学带来了巨大的挑战。     

老年人药物不良反应分析及对策

随着人们生活及卫生保健的改善，人的平均寿命显著延长，许多疾病也就随着年龄的增大而增长，人老病多，特别是慢性疾病。老年人同时使用多种药物治疗的情况很常见，通常都用3—4种药物，甚至10种以上。这样多种药物同时使用，势必使药物不良反应（ADR）和药物中毒的可能性增加，对老年人的安全和健康构成了很大威胁，随差我国老龄人口不断增加，     

Inappropriate medication use in older adults undergoing surgery: a national study

OBJECTIVES: To determine the prevalence and factors associated with use of potentially inappropriate medications (PIMs) in older adults undergoing surgery. DESIGN: Retrospective cohort study. SETTING: Three hundred seventy‐nine acute care hospitals participating in the nationally representative Perspective database (2006–2008). PARTICIPANTS: Individuals aged 65 and older undergoing major inpatient gastrointestinal, gynecological, urological, and orthopedic surgery (N=272,351). MEASUREMENTS: Medications were classified as PIMs using previously published criteria defining 33 medications deemed potentially inappropriate in people aged 65 and older. Information about participant and provider characteristics and administration of PIMs was obtained from hospital discharge file data. Logistic regression techniques were used to examine factors associated with use of PIMs in the perioperative period. RESULTS: One‐quarter of participants received at least one PIM during their surgical admission. Meperidine was the most frequently prescribed PIM (37,855, 14% of participants). In adjusted analysis, PIM use was less likely as age advanced (adjusted odds ratio (AOR)=0.98 per year of age, 95% confidence interval (CI)=0.97–0.98) and in men (AOR=0.83, 95% CI=0.81–0.85). PIMs were more likely to be prescribed to participants cared for by orthopedic surgeons than for those cared for by general surgeons (AOR=1.22, 95% CI=1.08–1.40). Participants undergoing surgery in the West (AOR=1.79, 95% CI=1.02–3.16) and South (AOR=2.24, 95% CI=1.38–3.64) were more likely to receive a PIM than those in the Northeast. CONCLUSION: Receipt of PIMs in older adults undergoing surgery is common and varies widely between providers and geographic regions and according to participant characteristics. Interventions aimed at reducing the use of PIMs in the perioperative period should be considered in quality improvement efforts.     

Characteristics of inappropriate multiple medication use in older urological outpatients

ObjectivesTo investigate polypharmacy and potentially inappropriate medications (PIMs) in elderly patients visiting the urology department for lower urinary tract symptoms (LUTS).MethodsWe retrospectively analyzed digital medical records of individuals over the age of 65 who visited the urology department for LUTS. This cross-sectional study was conducted in 10 hospitals located in South Korea, between September 2017 and December 2017. All prescribed medications were analyzed using electronic medical records. The updated 2015 Beers criteria were used to identify and assess the appropriateness of the prescribed drugs in elderly patients.ResultsWe analyzed a total of 2143 patients aged over 65 years from 10 institutions. The mean age was 74.2 ± 6.26 years (65–97), 1634 (76.2%) were men. Patients took a mean of 6.48 ± 2.46 medications (range 0–18), and polypharmacy was found in 1762 patients (82.2%). The number of patients who received PIMs at least once was 1579 (73.7%). The average number of PIMs used per patient was 1.31 ± 1.25 (0–7). PIM use ratio was 18.9 ± 0.15% (0–67%). The number of chronic diseases, and concurrent medication and polypharmacy were predictive factors associated with PIM use.ConclusionOur multi-institutional results show that a substantial proportion of elderly patients took PIMs when visiting the urology department. Factors associated with PIMs were the number of chronic diseases and polypharmacy. Medication use in elderly patients, especially in urology, should be monitored carefully.     

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

Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modified Delphi method to the systematic review and grading to reach consensus on the updated 2012 AGS Beers Criteria. Fifty-three medications or medication classes encompass the final updated Criteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria. Thoughtful application of the Criteria will allow for (a) closer monitoring of drug use, (b) application of real-time e-prescribing and interventions to decrease ADEs in older adults, and (c) better patient outcomes.     

Potentially Inappropriate Medications and Functional Decline in Elderly Hospitalized Patients

OBJECTIVES: To verify whether the use of potentially inappropriate medications (PIMs) is associated with loss of independence in elderly in-patients by promoting adverse drug reactions (ADRs).
DESIGN: Prospective observational study.
PARTICIPANTS: Five hundred six patients aged 65 and older admitted to 11 acute care medical wards.
MEASUREMENTS: In-hospital loss of one or more activities of daily living (ADLs) and three or more ADLs. PIMs were identified according to diagnosis-independent Beers criteria and ascertained by study physicians based on daily review of medical and nurse records. The relationship between risk factors and outcomes was assessed using logistic regression.
RESULTS: Overall, 104 patients (20.6%) were taking at least one PIM at the time of admission (baseline users), and 49 (9.7%) were newly prescribed at least one PIM during their hospital stay. The loss of one or more ADLs occurred in 9.6% of baseline users, 16.3% of new users, and 8.5% of nonusers ( P =.21) and that of three or more ADLs in 7.7% of baseline users, 12.2% of new users, and 4.8% of nonusers ( P =.10). The lack of association was confirmed after correction for potential confounders, including ADRs. The occurrence of ADRs was strongly associated with both outcomes (odds ratio (OR)=7.80, 95% confidence interval (CI)=3.53–17.3 for the loss of ≥1 ADLs; OR=3.98, 95% CI=1.50–10.5 for the loss of ≥3 ADLs), but PIMs caused only six of 106 ADRs.
CONCLUSIONS: ADRs to any drugs more than the use of PIMs might be associated with functional decline in elderly hospitalized patients, but because the power of this study was too limited to definitively exclude a direct relationship between PIMs and functional decline, this merits further investigation.     

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.