Egger Sabin S, Bachmann Andrea, Hubmann Nathalie, Schlienger Raymond G, Krähenbühl Stephan
Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland.
Drugs Aging. 2006;23(10):823-37. doi: 10.2165/00002512-200623100-00005.
Inappropriate drug use is one of the risk factors for adverse drug reactions in the elderly. We hypothesised that, in elderly patients, geriatricians are more aware of potentially inappropriate medications (PIMs) and may replace or stop PIMs more frequently compared with internists. We therefore evaluated and compared the prevalence of PIMs as well as anticholinergic drug use throughout hospital stay in elderly patients admitted to a medical or geriatric ward.
In this retrospective cross-sectional study, 800 patients aged > or =65 years admitted to a general medical or geriatric ward of a 700-bed teaching hospital in Switzerland during 2004 were included. PIMs were identified using the Beers criteria published in 2003. The prevalence of anticholinergic drug use was assessed based on drug lists published in the literature.
The prevalence of use of PIMs that should generally be avoided was similar in medical and geriatric inpatients both at admission (16.0% vs 20.8%, respectively; p = 0.08) and at discharge (13.3% vs 15.9%, respectively; p = 0.31). In contrast to medical patients, the reduction in the prevalence of use of PIMs between admission and discharge in geriatric patients reached statistical significance (p < 0.05). Overall, the three most prevalent inappropriate drugs/drug classes were amiodarone, long-acting benzodiazepines and anticholinergic antispasmodics. At admission, the prevalence of use of PIMs related to a specific diagnosis was not significantly different between patients hospitalised to a medical or a geriatric ward (14.0% vs 17.5%, respectively; p = 0.17), as compared with the significant difference evident at hospital discharge (11.7% vs 23.7%, respectively; p < 0.001). This was largely because of a higher prescription rate of platelet aggregation inhibitors in combination with low-molecular-weight heparins and benzodiazepines in patients with a history of falls and syncope. The proportions of patients taking anticholinergic drugs in medical and geriatric patients at admission (13.0% vs 17.5%, respectively; p = 0.08) and discharge (12.2% vs 16.5%, respectively; p = 0.10) were similar.
Inappropriate drug use as defined by the Beers criteria was common in both medical and geriatric inpatients. Compared with internists, geriatricians appear to be more aware of PIMs that should generally be avoided, but less aware of PIMs related to a specific diagnosis, and of the need to avoid anticholinergic drug use. However, the results of this study should be interpreted with caution because some of the drugs identified as potentially inappropriate may in fact be beneficial when the patient's clinical condition is taken into consideration.
不适当用药是老年人药物不良反应的危险因素之一。我们假设，在老年患者中，老年病科医生比内科医生更了解潜在不适当用药（PIMs），并且可能更频繁地更换或停用PIMs。因此，我们评估并比较了入住内科或老年病科病房的老年患者住院期间PIMs以及抗胆碱能药物的使用情况。
在这项回顾性横断面研究中，纳入了2004年期间入住瑞士一家拥有700张床位的教学医院普通内科或老年病科病房的800例年龄≥65岁的患者。使用2003年发布的Beers标准识别PIMs。根据文献中公布的药物清单评估抗胆碱能药物的使用情况。
在入院时（分别为16.0%和20.8%；p = 0.08）和出院时（分别为13.3%和15.9%；p = 0.31），内科和老年病科住院患者中通常应避免使用的PIMs的使用率相似。与内科患者相比，老年患者入院至出院期间PIMs使用率的降低具有统计学意义（p < 0.05）。总体而言，三种最常见的不适当药物/药物类别为胺碘酮、长效苯二氮䓬类药物和抗胆碱能解痉药。入院时，入住内科或老年病科病房的患者中与特定诊断相关的PIMs使用率无显著差异（分别为14.0%和17.5%；p = 0.17），而出院时差异显著（分别为11.7%和23.7%；p < 0.001）。这主要是因为有跌倒和晕厥病史的患者中，血小板聚集抑制剂与低分子肝素和苯二氮䓬类药物联合使用的处方率较高。内科和老年病科患者入院时（分别为13.0%和17.5%；p = 0.08）和出院时（分别为12.2%和16.5%；p = 0.10）服用抗胆碱能药物的比例相似。
根据Beers标准定义的不适当用药在内科和老年病科住院患者中都很常见。与内科医生相比，老年病科医生似乎更了解通常应避免使用的PIMs，但对与特定诊断相关的PIMs以及避免使用抗胆碱能药物必要性的认识较低。然而，本研究结果应谨慎解读，因为一些被确定为潜在不适当的药物，在考虑患者临床情况时实际上可能是有益的。
