Aparasu Rajender R, Mort Jane R, Brandt Heather
College of Pharmacy, Box 2202 C, 1 Administration Lane, South Dakota State University, Brookings, SD 57007, USA.
Res Social Adm Pharm. 2005 Sep;1(3):446-59. doi: 10.1016/j.sapharm.2005.06.004.
Polypharmacy has been extensively studied internationally and reported to be increasing among the elderly. Within the United States, few studies have examined polypharmacy trends in the elderly population and even fewer studies addressed those at-risk for polypharmacy.
To examine the trends in office-based visits in the United States by the elderly involving polypharmacy and identify elderly at-risk for polypharmacy.
Data from the 1990 and 2000 National Ambulatory Medical Care Surveys were used to examine polypharmacy visit trends in the elderly. The Bonferroni inequality method was used to analyze the visit estimates and visit rates. Logistic regression analysis was used to model predisposing, enabling, and need factors associated with polypharmacy visits in the elderly using the 2000 survey data.
Office visits involving polypharmacy for elderly patients were estimated to have nearly quadrupled from 10.1 million in 1990 to 37.5 million in 2000. The proportion of visits by elderly patients involving polypharmacy was 7% in 1990 and 19% in 2000. The increase was consistent among all demographic groups and remained significant even after controlling for elderly population increase. Medication classes involved in polypharmacy remained consistent during the study period and included cardiovascular, hormonal, pain, and gastrointestinal medications. Analysis of the 2000 survey data revealed that several need (multiple diagnoses, chronic problems, and specific disease states), predisposing (female gender), and enabling factors (primary care provider visit and health insurance coverage) were associated with polypharmacy visits in the elderly.
The study found a significant increase in elderly patients' office visits involving polypharmacy in the United States. The study also found that several need, predisposing, and enabling factors were associated with polypharmacy visits in the elderly. These findings suggest opportunities to review and manage elderly patients' medications as recommended by Healthy People 2010, a national agenda to improve the health of Americans.
多重用药问题已在国际上得到广泛研究，据报道在老年人中呈上升趋势。在美国，很少有研究调查老年人群体中的多重用药趋势，而针对有多重用药风险人群的研究更少。
研究美国老年人在门诊就诊时涉及多重用药的趋势，并确定有多重用药风险的老年人。
利用1990年和2000年国家门诊医疗护理调查的数据来研究老年人多重用药就诊趋势。采用邦费罗尼不等式方法分析就诊估计数和就诊率。利用2000年调查数据，通过逻辑回归分析对与老年人多重用药就诊相关的易患因素、促成因素和需求因素进行建模。
据估计，老年患者涉及多重用药的门诊就诊次数从1990年的1010万次增加到2000年的3750万次，几乎增长了四倍。1990年老年患者涉及多重用药的就诊比例为7%，2000年为19%。各人口群体的增长趋势一致，即使在控制了老年人口增长之后，增长仍很显著。在研究期间，涉及多重用药的药物类别保持一致，包括心血管药物、激素类药物、止痛药物和胃肠道药物。对2000年调查数据的分析显示，几个需求因素（多种诊断、慢性疾病和特定疾病状态）、易患因素（女性）和促成因素（看初级保健医生和有医疗保险）与老年人多重用药就诊有关。
该研究发现美国老年患者涉及多重用药的门诊就诊次数显著增加。该研究还发现，几个需求、易患和促成因素与老年人多重用药就诊有关。这些发现表明，有机会按照《健康人民2010》（一项改善美国人健康的国家议程）的建议，对老年患者的用药进行审查和管理。
