Fauchais A-L, Ploquin I, Ly K, Rhaïem K, Bezanahary H, Tarnaud T, Soria P, Liozon E, Loustaud-Ratti V, Vidal E
Service de Médecine Interne A, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
Rev Med Interne. 2006 May;27(5):375-81. doi: 10.1016/j.revmed.2006.01.017. Epub 2006 Mar 3.
To analyse iatrogenic events in elderly people and determine the part of unplanned admission in postemergency units directly related to thus iatrogenic events.
The authors conducted a prospective chart review on treatments and potentials adverse drug-related events of all elderly consecutively hospitalized between January and Marsh 2003 in a postemergency department. A 6 months prospective evaluation after discharge was made for all elderly with adverse drug-related event.
One hundred (and) eighty-six elderly (mean age 83+/-5.7 years) were prospectively included. Eighty-one per cent are ambulatory with a self-medication administration in spite of a real disability (activity of daily-living: 4.5+/-1.8). The number of medications consumed ranged from 0 to 15 and averaged 6, with to different source of prescriptions in 34% of the cases. The treatment was recently modified in 41 cases (22%). Adverse drug related events accounted in 55 cases (29%) and hospitalization was directly related to iatrogenic event in 32 cases (17%). Adverse drug related events could be avoided in half cases. There was no death directly related with adverse drug reactions. Follow up after discharge was obtained in 47 cases and pointed out elderly disability: 34 were again hospitalized, 14 admitted in nursing home facilities and 12 died. Treatment was equivalent to our prescription only in 35% of the cases; on the other hand, we found only four elderly with medication directly related to previous adverse event.
Theses results pointed out once again polymedication observed in frail elderly people leading to extreme difficulty to prescription due to polypathology. Prescription renewal could be related to adverse drug related events and precipitated elderly people in disability leading to institutionalization.
分析老年患者的医源性事件，并确定急诊后单元中与这些医源性事件直接相关的非计划入院情况。
作者对2003年1月至3月在急诊后科室连续住院的所有老年患者的治疗情况和潜在的药物相关不良事件进行了前瞻性病历审查。对所有发生药物相关不良事件的老年患者出院后进行了6个月的前瞻性评估。
前瞻性纳入了186名老年患者（平均年龄83±5.7岁）。尽管存在实际残疾（日常生活活动能力：4.5±1.8），81%的患者仍能自行服药并走动。用药数量从0至15种不等，平均为6种，34%的病例有不同的处方来源。41例（22%）患者的治疗方案近期有调整。55例（29%）发生了药物相关不良事件，32例（17%）的住院与医源性事件直接相关。半数病例的药物相关不良事件可避免。没有死亡与药物不良反应直接相关。47例患者获得了出院后的随访，结果显示老年患者存在残疾情况：34例再次住院，14例入住养老院，12例死亡。仅35%的病例治疗方案与我们的处方一致；另一方面，我们仅发现4例老年患者的用药与既往不良事件直接相关。
这些结果再次指出，体弱老年患者存在多重用药情况，由于多种疾病导致处方极为困难。处方更新可能与药物相关不良事件有关，并使老年患者陷入残疾，最终导致入住养老院。
