Lövheim Hugo, Karlsson Stig, Gustafson Yngve
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
Pharmacoepidemiol Drug Saf. 2008 Sep;17(9):912-8. doi: 10.1002/pds.1600.
Old people in general, and particularly those with dementia, are more sensitive to adverse drug effects than younger people. Despite this, the use of central nervous system (CNS) drugs among old people is common. The aim of the present study was to compare the use of central nervous system drugs and analgesics among people aged 85 years or older, with and without dementia.
One half of all people aged 85 years old and all those aged 90, 95 and above in Umeå, Sweden and Vaasa and Mustasaari, Finland, were asked to participate in this part of the GERDA/Umeå 85+ study. Both those living in their own homes and those in institutions were included. Trained investigators performed structured interviews and assessments. Medication data were obtained from the participants and medical records. Dementia disorders were diagnosed according to DSM-IV.
Dementia was diagnosed in 247/546 participants (45.2%). A higher proportion of the participants with dementia used paracetamol (50.6% compared to 21.4%, p < 0.001), antipsychotics (22.3% and 2.7%, p < 0.001), antidepressants (33.6% and 11.4%, p < 0.001) and anxiolytics (19.0% and 8.0%, p < 0.001). There were no differences in the use of opioid analgesics, anticonvulsants and hypnotics.
The use of CNS drugs and analgesics was common among this population of very old people. Furthermore, the prescription of CNS drugs was more common among people with dementia. The use of antipsychotics in people with dementia should arouse particular concern, because of the high risk of severe adverse events and the limited evidence of positive effects.
一般而言，老年人，尤其是患有痴呆症的老年人，比年轻人对药物不良反应更敏感。尽管如此，老年人使用中枢神经系统（CNS）药物的情况仍很常见。本研究的目的是比较85岁及以上患有和未患有痴呆症的人群中中枢神经系统药物和镇痛药的使用情况。
瑞典于默奥、芬兰瓦萨和穆斯蒂萨里所有85岁的老人以及所有90岁、95岁及以上的老人中有一半被邀请参与GERDA/于默奥85+研究的这一部分。包括居家老人和机构老人。训练有素的调查人员进行结构化访谈和评估。从参与者和医疗记录中获取用药数据。根据《精神疾病诊断与统计手册》第四版（DSM-IV）诊断痴呆症。
546名参与者中有247名（45.2%）被诊断为痴呆症。患有痴呆症的参与者中使用对乙酰氨基酚的比例更高（50.6% 对比21.4%，p < 0.001）、抗精神病药物（22.3% 和2.7%，p < 0.001）、抗抑郁药物（33.6% 和11.4%，p < 0.001）以及抗焦虑药物（19.0% 和8.0%，p < 0.001）。阿片类镇痛药、抗惊厥药和催眠药的使用情况没有差异。
在这群高龄人群中，中枢神经系统药物和镇痛药的使用很普遍。此外，中枢神经系统药物的处方在患有痴呆症的人群中更常见。由于严重不良事件的高风险以及积极效果的证据有限，痴呆症患者使用抗精神病药物应引起特别关注。
