Laroche Marie-Laure, Charmes Jean-Pierre, Nouaille Yves, Picard Nicolas, Merle Louis
Department of Pharmacology-Toxicology, University Hospital Dupuytren and Department of Geriatrics, Hospital Rebeyrol, Limoges, France.
Br J Clin Pharmacol. 2007 Feb;63(2):177-86. doi: 10.1111/j.1365-2125.2006.02831.x. Epub 2006 Dec 7.
To study the occurrence of adverse drug reactions (ADRs) linked to inappropriate medication (IM) use in elderly people admitted to an acute medical geriatric unit.
All the elderly people aged > or = 70 years admitted to the acute medical geriatric unit of Limoges University hospital (France) over a 49-month period were included, whatever their medical condition. For all the patients, clinical pharmacologists listed the medications given before admission and identified the possible ADRs. The appropriateness of these medications and the causal relationship between drugs (either appropriate or not) and ADRs were evaluated.
Two thousand and eighteen patients were included. The number of drugs taken was 7.3 +/- 3.0 in the patients with ADRs and 6.0 +/- 3.0 in those without ADRs (P < 0.0001). Sixty-six percent of the patients were given at least one IM prior to admission. ADR prevalence was 20.4% among the 1331 patients using IMs and 16.4% among those using only appropriate drugs (P < 0.03). In only 79 of the 1331 IM users (5.9%) were ADRs directly attributable to IMs. The IMs most often involved in patients with ADRs were: anticholinergic antidepressants, cerebral vasodilators, long-acting benzodiazepines and concomitant use of two or more psychotropic drugs from the same therapeutic class. Using multivariate analysis, after adjusting for confounding factors, IM use was not associated with a significant increased risk of ADRs (odds ratio 1.0, 95% confidence interval 0.8, 1.3).
Besides a reduction in the number of drugs given to the elderly, a good prescription should involve a reduction in the proportion of IMs and should take into consideration the frailty of these patients.
研究入住老年急性内科病房的老年人中与不适当用药相关的药物不良反应（ADR）的发生情况。
纳入法国利摩日大学医院老年急性内科病房在49个月期间收治的所有年龄≥70岁的老年人，无论其病情如何。对于所有患者，临床药理学家列出入院前使用的药物并确定可能的ADR。评估这些药物的适当性以及药物（无论适当与否）与ADR之间的因果关系。
共纳入2018例患者。发生ADR的患者用药数量为7.3±3.0种，未发生ADR的患者用药数量为6.0±3.0种（P<0.0001）。66%的患者在入院前至少接受了一种不适当用药。在1331例使用不适当用药的患者中，ADR发生率为20.4%，而仅使用适当药物的患者中ADR发生率为16.4%（P<0.03）。在1331例不适当用药使用者中，只有79例（5.9%）的ADR可直接归因于不适当用药。与ADR相关的最常见不适当用药为：抗胆碱能抗抑郁药、脑血管扩张剂、长效苯二氮䓬类药物以及同时使用两种或更多来自同一治疗类别的精神药物。使用多变量分析，在调整混杂因素后，不适当用药与ADR风险显著增加无关（比值比1.0，95%置信区间0.8，1.3）。
除了减少老年人的用药数量外，良好的处方应包括减少不适当用药的比例，并应考虑到这些患者的虚弱状况。
