Liu Gordon G, Christensen Dale B
Division of Pharmaceutical Policy and Evaluative Sciences, School of Pharmacy, University of North Carolina-Chapel Hill, 27599-7360, USA.
J Am Pharm Assoc (Wash). 2002 Nov-Dec;42(6):847-57. doi: 10.1331/108658002762063682.
To provide an updated review of the literature on the extent of and risk factors for inappropriate prescribing in the elderly.
A comprehensive review of the most recent publications in English assessing inappropriate prescriptions for elderly patients in the United States using the 1997 version of the Beers explicit criteria. The reviewed articles were obtained via an electronic search of the MEDLINE database for articles published between 1997 and 2001 and a manual search through major journals for articles referenced in those located through MEDLINE. Search terms were Beers, explicit criteria, inappropriate drug use, prescribing, prescriptions, medication use, elderly, and health outcomes.
Using the updated explicit criteria, a total of 11 empirical studies were identified, all of which were conducted using observational surveys or claims databases. The reported prevalence of elderly patients using at least one inappropriately prescribed drug ranged from a high of 40% for a population of nursing home patients to 21.3% for community-dwelling patients over age 65. Propoxyphene, amitriptyline, long-acting benzodiazepines (e.g., chlordiazepoxide, diazepam, flurazepam), and dipyridamole are among the most commonly occurring inappropriate prescriptions. With a few exceptions, the most significant patient-related predictors of inappropriate prescribing include polypharmacy, poor health status, and female sex. Other potential risk factors include prescribing location, ethnicity, age, and referral status. Limited evidence was found of increased health care utilization and poorer quality of life resulting from inappropriate drug use in the elderly in Medicare health maintenance organization and emergency department settings.
The prevalence of inappropriate prescribing remains alarmingly high for the elderly in general and for nursing home residents in particular. This review identified some attributes of the elderly groups most vulnerable to inappropriate prescribing. Future research should document more evidence regarding the adverse impact of inappropriate prescribing on total health care costs and patient health outcomes.
对有关老年人不适当用药的程度及危险因素的文献进行更新综述。
使用1997年版的《Beers明确标准》，对评估美国老年患者不适当处方的最新英文出版物进行全面综述。通过对MEDLINE数据库进行电子检索，查找1997年至2001年间发表的文章，并通过手动检索主要期刊，查找通过MEDLINE检索到的文章中引用的文章。检索词包括Beers、明确标准、不适当药物使用、开处方、处方、药物使用、老年人和健康结果。
使用更新后的明确标准，共确定了11项实证研究，所有这些研究均采用观察性调查或索赔数据库进行。报告显示，使用至少一种不适当处方药物的老年患者患病率，在养老院患者群体中高达40%，在65岁以上的社区居住患者中为21.3%。丙氧芬、阿米替林、长效苯二氮䓬类药物（如氯氮卓、地西泮、氟西泮）和双嘧达莫是最常见的不适当处方药物。除了少数例外，与患者相关的不适当处方最重要的预测因素包括多种药物治疗、健康状况差和女性性别。其他潜在危险因素包括开处方地点、种族、年龄和转诊状态。在医疗保险健康维护组织和急诊科环境中，发现有限的证据表明老年人不适当用药会导致医疗保健利用率增加和生活质量下降。
总体而言，老年人尤其是养老院居民中不适当用药的患病率仍然高得惊人。本综述确定了最容易出现不适当用药的老年人群体的一些特征。未来的研究应记录更多关于不适当用药对总体医疗保健成本和患者健康结果的不利影响的证据。
