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41.
L. J. G. Veehof R. E. Stewart B. Meyboom-de Jong F. M. Haaijer-Ruskamp 《European journal of clinical pharmacology》1999,55(7):533-536
Objectives: The risk of adverse drug reactions (ADRs) increases with the number of drugs used. Most studies refer to potential interactions;
the results regarding the severity of occurring and registered ADRs are inconsistent. Therefore, we examined the relevance
of drug-induced problems in the elderly in general practice and their association with polypharmacy.
Design: Retrospective cross-sectional analysis of prospectively collected data.
Setting: Three family practices participating in the medication and morbidity Registration Network Groningen (RNG).
Methods: From 2185 elderly patients (>64 years) medication and morbidity data were collected over the period of 2 years (1994 and
1995). Polypharmacy was defined as the long-term simultaneous use of two or more drugs. Adverse reactions recognised as such
were coded as a separate `diagnosis' A85. The most risky drug groups and the most prevalent diseases in relation to ADRs were
studied.
Results: The incidence of ADRs in general practice was 5.7 per 100 elderly patients and the prevalence 6.1 per 100. Moderate polypharmacy
was more frequent in the elderly who experienced adverse effects; no other differences in degree of polypharmacy could be
found. The elderly who experienced adverse reactions used overall more different drugs (14.4 ± 7.6, of which 1.5 ± 1.5 were
used long term) than the other elderly patients (8.1 ± 5.7, of which 1.0 ± 1.5 were long term). The incidence of ADRs increased
non-significantly with the number of drugs used long term. Antibiotics, antihypertensives and non-steroidal anti-inflammatory
drugs were mainly responsible for gastrointestinal complaints (nausea, diarrhoea and stomach pain) and rash. In the cases
of treating urinary tract infections and sleeping disorders, there was a significantly high risk of ADRs. Slightly more at
risk for adverse drug reactions were older patients with coronary heart disease or asthma/chronic obstructive pulmonary disease.
Conclusion: Most of the ADRs observed in general practice turn out to be rather harmless. This is in agreement with outpatient studies,
though not with hospital studies. An increased risk of adverse effects with the number of drugs used simultaneously, as reported
in other studies, was not confirmed in our study. This study however is limited to actually registered effects.
Received: 4 December 1998 / Accepted in revised form: 10 June 1999 相似文献
42.
43.
由于艾滋病抗病毒药物的广泛使用,HIV感染者寿命得以延长,老年HIV感染者的人数不断增多,最终导致HIV合并慢性非传染性疾病(chronic non-communicable diseases,NCDs)的人群逐年递增。NCDs包括心血管疾病、糖尿病、癌症和慢性呼吸道疾病等,需要长期服用多种药物,加之复杂的HIV抗病毒药物方案,会导致HIV感染者服药依从性降低,出现错服、漏服等现象。HIV感染者多药依从性问题逐渐引起重视。该文系统回顾了HIV感染者合并NCDs多药依从性管理的相关研究,对HIV感染者合并NCDs多药依从性的定义和影响因素进行阐述,并提出提高合并NCDs的HIV感染者多药依从性的干预措施,以期为HIV感染者多药依从性管理的研究和护理实践提供参考。 相似文献
44.
Rosa Ana García Pliego Jos Miguel Baena Díez Yolanda Herreros Herreros Miguel ngel Acosta Benito 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2022,54(8)
El uso de fármacos conlleva innegables beneficios en las personas mayores, pero no está exento de efectos indeseables. La deprescripción es el proceso de revisión sistemática de la medicación con el objetivo de lograr la mejor relación riesgo-beneficio en base a la mejor evidencia disponible. Este proceso es especialmente importante en mayores polimedicados, sobretratados, frágiles, con enfermedades terminales y en el final de la vida.La deprescripción debe hacerse de forma escalonada, estableciendo un seguimiento estrecho por si aparecen problemas tras la retirada. En la toma de decisiones es muy importante contar con la opinión del paciente y de los cuidadores, valorando los objetivos del tratamiento según la situación clínica, funcional y social del enfermo.Existen múltiples herramientas para facilitar a los clínicos la tarea de seleccionar qué fármacos deprescribir (criterios Beers, STOPP-START…). Los grupos farmacológicos más susceptibles de intervención son: antihipertensivos, antidiabéticos, estatinas, benzodiacepinas, antidepresivos, anticolinérgicos, anticolinesterásicos y neurolépticos.Palabras clave: Polifarmacia, Envejecimiento, Comorbilidad, Prescripción inadecuada, Efectos adversos, Deprescripción 相似文献
45.
Davide Liborio Vetrano Emanuele Rocco Villani Giulia Grande Silvia Giovannini Maria Camilla Cipriani Ester Manes-Gravina Roberto Bernabei Graziano Onder 《Journal of the American Medical Directors Association》2018,19(8):710-713
Objectives
To test the association between polypharmacy and 1-year change in physical and cognitive function among nursing home (NH) residents.Design
Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study.Setting
NH in Europe (n = 50) and Israel (n = 7).Participants
3234 NH older residents.Measurements
Participants were assessed through the interRAI long-term care facility instrument. Polypharmacy was defined as the concurrent use of 5 to 9 drugs and excessive polypharmacy as the use of ≥10 drugs. Cognitive function was assessed through the Cognitive Performance Scale (CPS). Functional status was evaluated through the Activities of Daily Living (ADL) Hierarchy scale. The change in CPS and ADL score, based on repeated assessments, was the outcome, and their association with polypharmacy was modeled via linear mixed models. The interaction between polypharmacy and time was reported [beta and 95% confidence intervals (95% CIs)].Results
A total of 1630 (50%) residents presented with polypharmacy and 781 (24%) excessive polypharmacy. After adjusting for potential confounders, residents on polypharmacy (beta 0.10, 95% CI 0.01-0.20) and those on excessive polypharmacy (beta 0.13, 95% CI 0.01-0.24) had a significantly higher decline in CPS score compared to those using <5 drugs. No statistically (P > .05) significant change according to polypharmacy status was shown for ADL score.Conclusions
Polypharmacy is highly prevalent among older NH residents and, over 1 year, it is associated with worsening cognitive function but not functional decline. 相似文献46.
BackgroundSurvival in older adults has a high variability. The possible association of length of survival with potentially inappropriate medication (PIM) use remains unclear.AimTo examine the four-year survival rate, the prevalence of polypharmacy and PIM use at admission, and the association between the two, in an inception cohort of newly admitted nursing home residentsMethodsData were used from ageing@NH, a prospective observational cohort study in nursing homes. Residents (n = 613) were followed for four years after admission or until death. PIM use was measured at admission, using STOPPFrail. The Kaplan-Meier method was used to estimate survival, using log-rank tests for subgroup analyses. Cox regression analyses was used to explore associations with PIM use and polypharmacy, corrected for covariatesResultsMean age was 84, 65% were females. After one, two, three and four years the survival rates were respectively 79%, 60.5%, 47% and 36%. At admission, 47% had polypharmacy and 40% excessive polypharmacy, 11% did not use any PIMs, and respectively 28%, 29%, and 32% used one, two and three or more PIMs. No difference in survival was found between polypharmacy and no polypharmacy, and PIM use and no PIM use at admission. Neither polypharmacy nor PIM use at admission were associated with mortality.ConclusionResidents survived a relatively short time after NH admission. Polypharmacy and PIM use at admission were relatively high in this cohort, although neither was associated with mortality. 相似文献
47.
48.
Messinger-Rapport BJ Morley JE Thomas DR Gammack JK 《Journal of the American Medical Directors Association》2011,12(9):615-626
This represents the fifth article in the series?on yearly updates of hot topics in long term care. 相似文献
49.
50.
《Research in social & administrative pharmacy》2022,18(9):3492-3500
BackgroundPolypharmacy is commonly related to poor drug adherence, decreased quality of life and inappropriate prescribing in eldery. Furthermore, this condition also leads to a higher utilization of health services resources, due to the increased risk of adverse drug events, length of stays in hospitals and readmissions rates after discharge.ObjectiveThis Systematic Review aimed to synthesize the current evidence that evaluates pharmaceutical services on polymedicated patients, from an economic perspective.MethodsSystematic searches were conducted in MEDLINE, SCOPUS and Cochrane Library databases to identify studies that were published until January 2021. Experimental and observational studies were included in this review, using strict inclusion/exclusion criteria and were assessed for quality using the following tools: RoB and ROBINS-I. Two independent reviewers selected the articles and extracted the data.Results3,662 articles were retrieved from the databases. After the screening, 18 studies were included: 9 experimental and 9 observational studies. The studies reported that the integration of the pharmacist as a member of the healthcare team provides an optimized use of pharmacotherapy to polymedicated patients and contributes to health promotion, providing reduction of spending on medication, reduction of expenses related to emergency care and hospitalizations and other medical expenses. The ECRs made cost-effectiveness or cost-benefit analysis, and most of the Non Randomized studies had statistically significant cost savings even considering the expenses of pharmaceutical assistance. Experimental studies reported a cost reduction varying between US$ 193 to US$ 4,966 per patient per year. Furthermore, observational studies estimated a cost reduction of varying from US$ 3 to US$ 2,505 per patient per year. The cost savings are related to decrease in emergency visits and hospitalizations, through pharmacist intervention (medication review and pharmacotherapy follow-up).ConclusionsConsidering the set of studies included, pharmaceutical care services directed to polymedicated patients may cooperate to save financial resources. Most of the interventions showed positive economic trends and also contributed to improving clinical parameters and quality of life. However, due to the majority of the studies having exploratory or qualitative methodology, it is essential to carry out more robust studies, based on full economic evaluation. 相似文献