School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland.
Drugs Aging. 2009;26(12):1039-48. doi: 10.2165/11319530-000000000-00000.
Increased use of drugs has raised concern about the risks of polypharmacy in elderly populations. Adverse outcomes, such as hospitalizations and falls, have been shown to be associated with polypharmacy. So far, little information is available on the association between polypharmacy status and mortality.
To assess whether polypharmacy (six to nine drugs) or excessive polypharmacy (ten or more drugs) could be indicators of mortality in elderly persons.
This was a population-based cohort study conducted between 1998 and 2003 with mortality follow-up through to 2007. The data in this study were derived from the population-based Kuopio 75+ Study, which involved elderly persons aged>or=75 years living in the city of Kuopio, Finland. The initial sample (sample frame n=4518, random sample n=700) was drawn from the population register. For the purpose of this study, two separate analyses were carried out. In the first phase, participants (aged>or=75 years, n=601) were followed from 1998 (baseline) to 2002. In the second phase, survivors (aged>or=80 years, n=339) were followed from 2003 to 2007. Current medications were determined from drug containers and prescriptions during interviews conducted by a trained nurse. The Kaplan-Meier method and Cox proportional hazards regression were used to examine the association between polypharmacy status and mortality.
In the first phase, 28% (n=167) belonged to the excessive polypharmacy group, 33% (n=200) to the polypharmacy group, and the remaining 39% (n=234) to the non-polypharmacy (0-5 drugs) group. The corresponding figures in the second phase were 28% (n=95), 39% (n=132) and 33% (n=112), respectively. The mortality rate was 37% in the first phase and 40% in the second phase. In both phases, the survival curves showed a significant difference in all-cause mortality between the three polypharmacy groups. In the first phase, the univariate model showed an association between excessive polypharmacy and mortality (hazard ratio [HR] 2.53, 95% CI 1.83, 3.48); however, after adjustment for demographics and other variables measuring functional and cognitive status, this association did not remain statistically significant (HR 1.28, 95% CI 0.86, 1.91). In the second phase, the association between excessive polypharmacy and mortality (HR 2.23, 95% CI 1.21, 4.12) remained significant after adjustments. Age, male sex and dependency according to the Instrumental Activities of Daily Living screening instrument were associated with mortality in both phases.
This study points to the importance of excessive polypharmacy as an indicator for mortality in elderly persons. This association needs to be confirmed following adjustment for co-morbidities.
药物使用的增加引发了人们对老年人中药物滥用风险的担忧。已有研究表明，不良后果，如住院和跌倒，与药物滥用有关。迄今为止，关于药物滥用状况与死亡率之间的关联的信息有限。
评估是否存在六至九种药物的药物滥用或十种或更多药物的过度药物滥用可以作为老年人死亡率的指标。
这是一项基于人群的队列研究，于 1998 年至 2003 年进行，死亡率随访至 2007 年。本研究的数据来自基于人群的库奥皮奥 75+研究，该研究涉及芬兰库奥皮奥市 75 岁以上的老年人。初始样本（样本量 4518，随机样本量 700）取自人口登记册。为了进行本研究，进行了两项单独的分析。在第一阶段，参与者（年龄≥75 岁，n=601）从 1998 年（基线）随访至 2002 年。在第二阶段，幸存者（年龄≥80 岁，n=339）从 2003 年随访至 2007 年。当前的药物治疗是通过受过培训的护士进行的访谈期间从药物容器和处方中确定的。Kaplan-Meier 法和 Cox 比例风险回归用于检查药物滥用状况与死亡率之间的关联。
在第一阶段，28%（n=167）属于过度药物滥用组，33%（n=200）属于药物滥用组，其余 39%（n=234）属于非药物滥用（0-5 种药物）组。第二阶段的相应数字分别为 28%（n=95）、39%（n=132）和 33%（n=112）。第一阶段的死亡率为 37%，第二阶段为 40%。在两个阶段中，所有原因死亡率的生存曲线均显示三组药物滥用者之间存在显著差异。在第一阶段，单变量模型显示过度药物滥用与死亡率之间存在关联（危险比[HR]2.53，95%置信区间 1.83，3.48）；然而，在调整人口统计学和其他衡量功能和认知状态的变量后，这种关联不再具有统计学意义（HR 1.28，95%置信区间 0.86，1.91）。在第二阶段，过度药物滥用与死亡率之间的关联（HR 2.23，95%置信区间 1.21，4.12）在调整后仍然显著。年龄、男性性别和根据工具性日常生活活动筛查工具确定的依赖与两个阶段的死亡率相关。
本研究指出了过度药物滥用作为老年人死亡率指标的重要性。这种关联需要在调整合并症后得到证实。
