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痴呆患者潜在不适当药物使用。

Potentially Inappropriate Medication Use in Patients with Dementia.

机构信息

Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea.

Department of Pharmacy, Kyung Hee University Hospital, Seoul 02447, Korea.

出版信息

Int J Environ Res Public Health. 2022 Sep 10;19(18):11426. doi: 10.3390/ijerph191811426.

Abstract

The objective of this study was to characterize the epidemiology of using potentially inappropriate medications associated with dementia exacerbation (DPIMs) in elderly outpatients with dementia. Electronic medical records were retrospectively reviewed for geriatric patients with dementia who were prescribed at least one medication in 2016 at a tertiary, university-affiliated hospital. The 2015 Beers criteria were used to define DPIMs. Logistic regression was performed to identify factors associated with prescribing DPIMs in patients with dementia. Among 2100 patients included in our study, 987 (47.0%) patients were prescribed at least one DPIM. Benzodiazepines were the most frequently prescribed DPIM followed by anticholinergics, histamine H2-receptor blockers, and zolpidem. The risk of prescribing DPIMs was significantly increased in female patients (odds ratio (OR) 1.355) with polypharmacy (OR 5.146) and multiple comorbidities (OR 1.129) ( < 0.05 for all). Coexistence of Parkinson's disease (OR 1.799), mood disorder (OR 1.373), or schizophrenia (OR 4.116) in patients with dementia further increased the likelihood of receiving DPIMs. In conclusion, DPIMs were commonly used in elderly patients with dementia in Korea with benzodiazepines most frequently prescribed followed by anticholinergics. Female patients using polypharmacy with multiple comorbidities should be closely monitored to minimize unnecessary DPIM use and, ultimately, DPIM-related harms.

摘要

本研究旨在描述与痴呆恶化相关的潜在不适当药物(DPIMs)在老年痴呆门诊患者中的使用流行病学。对 2016 年在一家三级大学附属医院至少开一种药物的老年痴呆患者的电子病历进行了回顾性审查。2015 年 Beers 标准用于定义 DPIMs。采用逻辑回归分析确定痴呆患者处方 DPIMs 的相关因素。在我们的研究中,包括 2100 名患者,其中 987 名(47.0%)患者至少开了一种 DPIM。苯二氮䓬类药物是最常开的 DPIM,其次是抗胆碱能药物、组胺 H2 受体阻滞剂和唑吡坦。女性患者(优势比(OR)1.355)、多药治疗(OR 5.146)和多种合并症(OR 1.129)的 DPIM 处方风险显著增加(所有 P 值均<0.05)。痴呆患者同时患有帕金森病(OR 1.799)、情绪障碍(OR 1.373)或精神分裂症(OR 4.116),进一步增加了接受 DPIMs 的可能性。总之,韩国老年痴呆症患者中 DPIMs 常用,最常开的是苯二氮䓬类药物,其次是抗胆碱能药物。应密切监测使用多种合并症的多药治疗的女性患者,以尽量减少不必要的 DPIM 使用,并最终减少 DPIM 相关危害。

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