老年多病共存且用药复杂的中国住院患者潜在不适当用药的患病率及危险因素：一项横断面研究
The prevalence and risk factors of potentially inappropriate medication use in older Chinese inpatients with multimorbidity and polypharmacy: a cross-sectional study.
作者信息
Tian Fangyuan, Liao Shili, Chen Zhaoyan, Xu Ting
机构信息
Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
出版信息
Ann Transl Med. 2021 Sep;9(18):1483. doi: 10.21037/atm-21-4238.
BACKGROUND
Multimorbidity and polypharmacy are common problems among the older population globally. They not only reduce the quality of life of older adults but also increase the prevalence of potentially inappropriate medication (PIM) use. This study aimed to examine the prevalence and the predictors of PIMs in hospitalized geriatric patients with multimorbidity and polypharmacy in Chengdu based on the 2015 American Geriatric Society Beers Criteria (2015 AGS Beers Criteria) and 2019 American Geriatric Society Beers Criteria (2019 AGS Beers Criteria).
METHODS
From 2016 to 2018, a cross-sectional study was conducted using electronic medical data from nine tertiary hospitals in Chengdu. The 2019 and 2015 AGS Beers Criteria were used to evaluate the PIM status of older inpatients (age ≥65 years), and logistic regression was used to identify the risk factors for PIM use.
RESULTS
A total of 17,352 inpatients were included in the study between 2016 and 2018. The prevalence of PIM use based on the 2019 AGS Beers Criteria (72.54%) was slightly higher than that based on the 2015 AGS Beers Criteria (70.10%). Further, the prevalence of PIM use based on the 2019 AGS Beers Criteria showed an increasing trend, from 71.17% in 2016 to 73.39% in 2018. Logistic regression demonstrated that female, advanced age, and polypharmacy were positively associated with PIM use in older adults. The most frequently used PIMs in the inpatients were diuretics, benzodiazepines, non-steroidal anti-inflammatory drugs, antipsychotics, and selective serotonin reuptake inhibitors.
CONCLUSIONS
There is a high prevalence of PIM use in older inpatients with multimorbidity and polypharmacy in Chengdu. The 2019 AGS Beers Criteria is more sensitive for evaluating older adults in Chengdu than the 2015 AGS Beers Criteria. Further, based on the 2019 AGS Beers Criteria, the prevalence of PIM use is increasing year by year. Research on interventions rationing PIM use in the geriatric population in Chengdu are necessary in the future.
背景
多病共存和多重用药是全球老年人群中常见的问题。它们不仅降低了老年人的生活质量，还增加了潜在不适当用药（PIM）的使用 prevalence。本研究旨在根据2015年美国老年医学会Beers标准（2015 AGS Beers标准）和2019年美国老年医学会Beers标准（2019 AGS Beers标准），调查成都患有多病共存和多重用药的住院老年患者中PIM的患病率及其预测因素。
方法
2016年至2018年，利用成都9家三级医院的电子医疗数据进行了一项横断面研究。采用2019年和2015年AGS Beers标准评估老年住院患者（年龄≥65岁）的PIM状态，并采用逻辑回归分析确定PIM使用的危险因素。
结果
2016年至2018年共有17352名住院患者纳入研究。基于2019年AGS Beers标准的PIM使用率（72.54%）略高于基于2015年AGS Beers标准的使用率（70.10%）。此外，基于2019年AGS Beers标准的PIM使用率呈上升趋势，从2016年的71.17%升至2018年的73.39%。逻辑回归显示，女性、高龄和多重用药与老年人PIM使用呈正相关。住院患者中最常使用的PIM是利尿剂、苯二氮卓类药物、非甾体抗炎药、抗精神病药和选择性5-羟色胺再摄取抑制剂。
结论
成都患有多病共存和多重用药的老年住院患者中PIM使用率较高。2019年AGS Beers标准在评估成都老年人方面比2015年AGS Beers标准更敏感。此外，基于2019年AGS Beers标准，PIM使用率逐年上升。未来有必要对成都老年人群中限制PIM使用的干预措施进行研究。
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