老年住院患者多重用药与老年综合征的关系
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摘要
目的研究老年住院患者多重用药与老年综合征的关系。方法应用老年综合评估方法调查老年住院患者用药清单及合并老年综合征情况。结果选取60岁以上老年住院患者281例,年龄(73. 6±7. 6)岁,平均共病5种,平均用药4种,多重用药占48. 0%。最常使用药物种类依次与下列慢性病有关:心脑血管疾病、消化系统、神经系统。最常使用药物依次为:阿司匹林92例32. 7%),阿托伐他汀65例(23. 1%),美托洛尔53例(18. 9%)。用药种类与共病数量呈显著正相关(r=0. 62,P <0. 01),多重共病患者多重用药风险显著增加(χ~2=32. 0,P <0. 01)。多重用药也与日常生活活动受损(χ~2=7. 4,P <0. 01)、衰弱(χ~2=6. 4,P=0. 02)、疼痛(χ~2=4. 7,P=0. 03)、便秘(χ~2=5. 8,P=0. 02)显著相关。结论老年科住院患者多重用药发生率高,同时伴随多种慢性情况,需要医师与药师合作,综合评估,并根据评估结果进行个体化全人管理和药物重整。
Objective To study the relationship of polypharmacy and geriatric syndrome among elder inpatients. Methods Determine geriatric syndrome and drug list after the evaluation of the patients with comprehensive geriatric assessment. Results A total of 281 inpatients aged over 60 years old accepted CGA during their hospitalization.The participants were at an age of( 73. 6 ± 7. 6) years with 5. 9 ± 4. 1 comorbidities,as well as an average number of4. 9 ± 3. 7 for medicine use. 48% had polypharmacy. The most commonly used prescription are drugs for cardio-cerebrovascular disease,digestive system diseases,neurological diseases,and the most common used drugs were aspirin 92( 32. 7%),atorvastatin 65( 23. 1 %) and metoprolol 53( 18. 9 %). Linear regression analysis revealed significant and independent association of number of drug use with number of comorbidities( P < 0. 001,B = 0. 62). Patients with multimobidity( χ~2= 32,P < 0. 01),dependence at ADL-IADL( χ~2= 7. 4,P < 0. 01),frailty( χ~2= 6. 4,P = 0. 02),pain( χ~2= 4. 7,P = 0. 03),or constipation( χ~2= 5. 8,P = 0. 02) had significantly higher rate of polypharmacy. Conclusions Elder inpatients had more multiple chronic conditions as well as more drugs use,it is nessesary for geriatric physicians to conduct CGA with the help of pharmacists among elder patients,and perform holistic management including medication reconciliation individually.
Objective To study the relationship of polypharmacy and geriatric syndrome among elder inpatients. Methods Determine geriatric syndrome and drug list after the evaluation of the patients with comprehensive geriatric assessment. Results A total of 281 inpatients aged over 60 years old accepted CGA during their hospitalization.The participants were at an age of( 73. 6 ± 7. 6) years with 5. 9 ± 4. 1 comorbidities,as well as an average number of4. 9 ± 3. 7 for medicine use. 48% had polypharmacy. The most commonly used prescription are drugs for cardio-cerebrovascular disease,digestive system diseases,neurological diseases,and the most common used drugs were aspirin 92( 32. 7%),atorvastatin 65( 23. 1 %) and metoprolol 53( 18. 9 %). Linear regression analysis revealed significant and independent association of number of drug use with number of comorbidities( P < 0. 001,B = 0. 62). Patients with multimobidity( χ~2= 32,P < 0. 01),dependence at ADL-IADL( χ~2= 7. 4,P < 0. 01),frailty( χ~2= 6. 4,P = 0. 02),pain( χ~2= 4. 7,P = 0. 03),or constipation( χ~2= 5. 8,P = 0. 02) had significantly higher rate of polypharmacy. Conclusions Elder inpatients had more multiple chronic conditions as well as more drugs use,it is nessesary for geriatric physicians to conduct CGA with the help of pharmacists among elder patients,and perform holistic management including medication reconciliation individually.
引文
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[12]PAMOUKDJIAN F,APARICIO T,ZELEK L,et al.Impaired mobility,depressed mood,cognitive impairment and polypharmacy are independently associated with disability in older cancer outpatients:The prospective Physical Frailty in Elderly Cancer patients(PF-EC)cohort study[J].J Geriatr Oncol,2017,8(3):190-195.
[13]HERR M,ROBINE J M,PINOT J,et al.Polypharmacy and frailty:prevalence,relationship,and impact on mortality in a French sample of 2350 old people[J].Pharmacoepidemiol Drug Saf,2015,24(6):637-646.
[14]ROSTED E,SCHULTZ M,SANDERS S.Frailty and polypharmacy in elderly patients are associated with a high readmission risk[J].Dan Med J,2016,63(9):A5274.
[15]KABBARA W K,DIMASSI H,SHEIKH-TAHA M.Patterns of pain medication use in older individuals with cardiovascular disease[J].Curr Med Res Opin,2018,34(5):931-934.
[16]GIOVANNINI S,VAN DER ROEST H G,CARFA,et al.Polypharmacy in Home Care in Europe:Cross-Sectional Data from the IBen C Study[J].Drugs Aging,2018,35(2):145-152.
[17]于普林,李增金,郑宏,等.老年人便秘流行病学特点的初步分析[J].中华老年医学杂志,2001,20(2):132-134.
[18]HIGGINS P D,JOHANSON J F.Epidemiology of constipation in North America:a systematic review[J].Am J Gastroenterol,2004,99(4):750-759.
[19]VRETTOS I,VOUKELATOU P,KATSORAS A,et al.Diseases linked to polypharmacy in elderly patients[J].Curr Gerontol Geriatr Res,2017:4276047.DOI:10.1155/2017/4276047.
[2]HALTER J B,OUSLANDER J G,STUDENSKI S,et al.Hazzard's geriatric medicine and gerontology[M].6 th E-dition.New York:McGraw-Hill Medical,2009:238.
[3]SEIDLING H M,STTZLE M,HOPPE-TICHY T,et al.Best practice strategies to safeguard drug prescribing and drug administration:an anthology of expert views and opinions[J].Int J Clin Pharm,2016,38(2):362-373.
[4]PEVNICK J M,PALMER K A,SHANE R.Potential benefit of electronic pharmacy claims data to prevent medication history errors and resultant inpatient order errors[J].J Am Med Inform Assoc,2016,23(5):942-950.
[5]GALLAGHER J,O'SULLIVAN D,MCCARTHY S,et al.Structured pharmacist review of medication in older hospitalised patients:a cost-effectiveness analysis[J].Drugs Aging.2016,33(4):285-294.
[6]BOYD C M,FORTIN M.Future of multimorbidity research:how should understanding of multimorbidity inform health system design?[J].Public Health Rev,32(2):451-474.
[7]INOUYE S K,STUDENSKI S,TINETTI M E.Geriatric syndromes:clinical,research,and policy implications of a core geriatric concept[J].J Am Geriatr Soc,2007,55(5):780-791.
[8]王海莲,陈莲珍.不合理用药调研概况与干预策略[J].中国药师,2005,8(4):335-336.
[9]邓应梅,汤哲,吴晓光.北京市社区老年患者疾病谱的变化研究[J].中国老年学,2009,29(7):867-870.
[10]BAHAT G,TUFAN F,BAHAT Z,et al.Comorbidities,polypharmacy,functionality and nutritional status in Turkish community-dwelling female elderly[J].Aging Clin Exp Res,2014,26(3):255-259.
[11]CONNOLLY D,GARVEY J,MCKEE G.Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing(TILDA)[J].Disabil Rehabil,2017,39(8):809-816.
[12]PAMOUKDJIAN F,APARICIO T,ZELEK L,et al.Impaired mobility,depressed mood,cognitive impairment and polypharmacy are independently associated with disability in older cancer outpatients:The prospective Physical Frailty in Elderly Cancer patients(PF-EC)cohort study[J].J Geriatr Oncol,2017,8(3):190-195.
[13]HERR M,ROBINE J M,PINOT J,et al.Polypharmacy and frailty:prevalence,relationship,and impact on mortality in a French sample of 2350 old people[J].Pharmacoepidemiol Drug Saf,2015,24(6):637-646.
[14]ROSTED E,SCHULTZ M,SANDERS S.Frailty and polypharmacy in elderly patients are associated with a high readmission risk[J].Dan Med J,2016,63(9):A5274.
[15]KABBARA W K,DIMASSI H,SHEIKH-TAHA M.Patterns of pain medication use in older individuals with cardiovascular disease[J].Curr Med Res Opin,2018,34(5):931-934.
[16]GIOVANNINI S,VAN DER ROEST H G,CARFA,et al.Polypharmacy in Home Care in Europe:Cross-Sectional Data from the IBen C Study[J].Drugs Aging,2018,35(2):145-152.
[17]于普林,李增金,郑宏,等.老年人便秘流行病学特点的初步分析[J].中华老年医学杂志,2001,20(2):132-134.
[18]HIGGINS P D,JOHANSON J F.Epidemiology of constipation in North America:a systematic review[J].Am J Gastroenterol,2004,99(4):750-759.
[19]VRETTOS I,VOUKELATOU P,KATSORAS A,et al.Diseases linked to polypharmacy in elderly patients[J].Curr Gerontol Geriatr Res,2017:4276047.DOI:10.1155/2017/4276047.