Burden of Potentially Harmful Medications and the Association With Quality of Life and Mortality Among Institutionalized Older People

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• 作者：Anna-Liisa Juola ; MD^a ; ^b ; ^{anna-liisa.juola@fimnet.fi" class="auth_mail" title="E-mail the corresponding author} ; Sarita Pylkkanen ; MSc (Pharm)^c ; Hannu Kautiainen ; PhD^b ; J. Simon Bell ; PhD^d ; Mikko P. Bjorkman ; MD ; PhD^b ; Harriet Finne-Soveri ; MD ; PhD^e ; Helena Soini ; RN ; PhD^f ; Kaisu H. Pitkä ; lä ; MD ; PhD^b
• 关键词：Inappropriate prescribing ; nursing home ; assisted living facilities ; quality of life ; psychological well-being
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 March 2016
• 年：2016
• 卷：17
• 期：3
• 页码：276.e9-276.e14
• 全文大小：354 K

文摘

This study investigated the overlap among 3 different definitions of potentially harmful medication (PHM) use and the corresponding associations with resident quality of life and mortality.

Design

Cross-sectional study with 3-year follow-up for mortality.

Setting

Assisted living facilities and nursing homes in Helsinki and Kouvola, Finland.

Participants

A total of 326 residents.

Measurements

PHM use was defined as (1) use of medications with anticholinergic properties, (2) use of Beers Criteria medications, and (3) concomitant use 3 or more psychotropic medications. Health-related quality of life (HRQoL) was assessed using the 15D and psychological well-being (PWB) scale. Residents self-rated their own health using a 4-point scale. Mortality data were obtained from central registers.

Results

There were 38.0%, 28.2%, and 12.6% of residents who used PHMs according to 1 (G1), 2 (G2), and 3 definitions (G3), respectively. Overall, 21.2% of residents did not use PHMs according to any of the 3 definitions (G0). There were no significant differences in comorbidity, cognition, or functioning among groups. In adjusted analyses, there was a stepwise association between use of multiple PHMs and poorer self-rated health, poorer PWB, and poorer HRQoL. There was no association in adjusted analyses between PHM use and 3-year mortality (47.8%–63.8%).

Conclusion

PHM use is highly prevalent in institutional settings, regardless of the definition of inappropriateness. Residents who used multiple categories of PHMs were at greatest risk of poor HRQoL, poor PWB, and poor self-rated health. However, there was no apparent association with increased mortality. Given the importance of quality of life as an outcome to older people, further efforts are needed to minimize PHM use in this setting.