Midlöv Patrik, Bondesson Asa, Eriksson Tommy, Petersson Jesper, Minthon Lennart, Höglund Peter
Department of Clinical Pharmacology, Lund University Hospital, Sweden.
Eur J Clin Pharmacol. 2002 Feb;57(12):903-10. doi: 10.1007/s00228-001-0408-3.
To describe the drug use in epilepsy and Parkinson's patients living in nursing homes and to evaluate the impact of multi-speciality team intervention on health-related quality of life, activities of daily living (ADL) and confusion state.
Nursing home residents with epilepsy or Parkinson's disease in the county of Skåne in Sweden were identified. From 119 nursing homes, 262 patients were identified. After obtaining informed consent, 157 patients from 48 nursing homes were included. Of these patients 74 were diagnosed with epilepsy and 84 with Parkinson's disease (one patient had both diagnoses). The average age of the epilepsy patients was 79 years and of the Parkinson's patients 81 years. Pharmacists documented the patients' drug use and any drug-related problems after communication with nursing-home residents, their contact persons at the nursing home and the residents' physicians. A multi-speciality group consisting of pharmacists, a primary care physician, a neurologist, a neuro-psychiatrist and a clinical pharmacologist evaluated the patients' medication and, when appropriate, suggested changes. Lists of each resident's medications were collected together with information about drug-related problems. The use of drugs deemed inappropriate for geriatric nursing-home residents according to Beer's criteria was documented. Health-related quality of life was evaluated using a generic health-related quality of life instrument, SF-36. Confusion state was measured using the Behaviour Pathology in Alzheimer's Disease Rating Scale (Behave-AD), and ability to perform ADL was assessed using the Schwab and England capacity for daily living scale. All measurements were repeated after approximately 6 months. During that period, for the group randomised to active intervention, the physicians involved in the care of the patients had received the recommendations for changes in drug treatment from the multi-speciality group.
Epilepsy patients at nursing homes used on average 8.0 drugs for continuous use whereas Parkinson's patients used 8.6 drugs. According to Beer's criteria about 40% of both patient groups used drugs that are classified as inappropriate to geriatric nursing-home patients. Dopamine receptor-blocking psychotropic drugs were used by 29% of the Parkinson's patients. Indication for a patient's total drug treatment was not documented for 50% of epilepsy and 40% of Parkinson's patients. There were no significant differences between the active and control groups in changes in SF-36, Behave-AD or ADL for epilepsy patients. For Parkinson's patients there was a significant decrease in ADL for the active group, whereas there were no differences in SF-36 or Behave-AD.
Nursing-home residents with epilepsy or Parkinson's disease use many drugs and often drugs that are classified as inappropriate. A simple problem-oriented questionnaire may be helpful in identifying specific drug-related problems in geriatric patients with common neurological diseases. Methods on how to improve the pharmacotherapy of these patients still have to be developed.
描述居住在养老院的癫痫和帕金森病患者的用药情况，并评估多专业团队干预对健康相关生活质量、日常生活活动（ADL）及意识模糊状态的影响。
确定瑞典斯科讷郡养老院中患有癫痫或帕金森病的居民。从119家养老院中识别出262名患者。在获得知情同意后，纳入了来自48家养老院的157名患者。其中74名患者被诊断为癫痫，84名患者被诊断为帕金森病（1名患者两种诊断均有）。癫痫患者的平均年龄为79岁，帕金森病患者的平均年龄为81岁。药剂师在与养老院居民、他们在养老院的联系人以及居民的医生沟通后，记录患者的用药情况及任何与药物相关的问题。一个由药剂师、初级保健医生、神经科医生、神经精神科医生和临床药理学家组成的多专业小组评估患者的用药情况，并在适当的时候建议进行调整。收集每位居民的用药清单以及与药物相关问题的信息。记录根据Beer标准被认为不适用于老年养老院居民的药物使用情况。使用通用的健康相关生活质量工具SF-36评估健康相关生活质量。使用阿尔茨海默病行为病理评定量表（Behave-AD）测量意识模糊状态，并使用施瓦布和英格兰日常生活能力量表评估ADL能力。所有测量在大约6个月后重复进行。在此期间，对于随机分配到积极干预组的患者，参与患者护理的医生已收到多专业小组关于药物治疗调整的建议。
养老院中的癫痫患者平均使用8.0种持续用药，而帕金森病患者使用8.6种。根据Beer标准，两个患者组中约40%使用了被归类为不适用于老年养老院患者的药物。29%的帕金森病患者使用了多巴胺受体阻断性精神药物。50%的癫痫患者和40%的帕金森病患者未记录其全部药物治疗的适应症。对于癫痫患者，积极干预组和对照组在SF-36、Behave-AD或ADL的变化方面没有显著差异。对于帕金森病患者，积极干预组的ADL有显著下降，而在SF-36或Behave-AD方面没有差异。
患有癫痫或帕金森病的养老院居民使用多种药物，且经常使用被归类为不适当的药物。一份简单的以问题为导向的问卷可能有助于识别患有常见神经系统疾病的老年患者中特定的药物相关问题。仍需开发改善这些患者药物治疗的方法。
