Institute of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
Drugs Aging. 2009 Dec;26 Suppl 1:15-30. doi: 10.2165/11534630-000000000-00000.
Older people take up a large proportion of health care, including drugs, and evidence shows that drug prescribing to this group is often inappropriate. Negative consequences of potential inappropriate drug prescription (PIDP) include adverse drug events, high healthcare service utilization and high costs for the patients and society. Although nursing home residents are the most vulnerable persons exposed to PIDP, few observational studies have investigated the prevalence, the factors associated with and the consequences of PIDP. Epidemiological studies assessing PIDP mainly based on the Beers' criteria showed that approximately half of US and Canadian nursing home residents have at least one PIDP in this setting. The most frequent inappropriate prescriptions concern neuroleptics and long-term benzodiazepines. Nursing home residents aged 80 years or more, those taking a low number of drugs, cognitive or communication problems are less exposed to PIDP compared with residents younger than 80 years, living in facilities with a high number of beds and a lower registered nurse-to-resident ratio. In European countries, the prevalence of PIDP among older nursing home residents was comparable to or higher than that observed in US and Canadian nursing homes. To date, the issue of PIDP has never been investigated in a representative sample of Italian nursing home residents. In a preliminary study performed by our group in 496 nursing home residents randomly selected from 40 nursing homes in Umbria, the prevalence of residents taking at least one or two inappropriate medications was 28% and 7%, respectively. The prevalence of PIDP considering diagnosis (18%) as well as those regardless of diagnosis (17%), as determined by Beers' criteria, were equally distributed in older Italian nursing home residents and no difference was found between sexes. Overall, this review reveals that the prevalence of PIDP is high in both North American and European nursing homes and highlights the urgent need for intervention trials testing strategies to reduce the health and social burden of PIDP.
老年人在医疗保健中占很大比例，包括药物治疗，有证据表明，给这一群体开处方往往是不恰当的。潜在不适当药物处方（PIDP）的负面后果包括药物不良事件、高医疗服务利用率和患者及社会的高成本。尽管养老院居民是最容易受到 PIDP 影响的弱势群体，但很少有观察性研究调查 PIDP 的流行率、相关因素以及 PIDP 的后果。基于 Beers 标准评估 PIDP 的流行病学研究表明，大约一半的美国和加拿大养老院居民在这种情况下至少有一种 PIDP。最常见的不适当处方涉及神经安定药和长期苯二氮䓬类药物。与 80 岁以下的居民相比，80 岁或以上的养老院居民、服用药物数量较少、认知或沟通问题较少的居民，以及居住在床位数量较多、注册护士与居民比例较低的机构中的居民，较少暴露于 PIDP 之下。在欧洲国家，老年养老院居民中 PIDP 的流行率与美国和加拿大养老院观察到的流行率相当或更高。迄今为止，PIDP 问题从未在意大利养老院居民的代表性样本中进行过调查。在我们小组进行的一项初步研究中，从翁布里亚的 40 家养老院中随机抽取了 496 名养老院居民，至少服用一种或两种不适当药物的居民比例分别为 28%和 7%。根据 Beers 标准，考虑诊断的 PIDP 患病率（18%）以及无论是否考虑诊断的 PIDP 患病率（17%）在意大利老年养老院居民中分布均匀，且在性别之间没有差异。总体而言，这篇综述表明，北美和欧洲养老院的 PIDP 患病率都很高，强调了迫切需要进行干预试验，以测试减少 PIDP 对健康和社会负担的策略。
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