Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Drugs Aging. 2010 Dec 1;27(12):1019-28. doi: 10.2165/11584990-000000000-00000.
Polypharmacy, the simultaneous taking of many medications, has been well documented and is a topic of much concern for those looking to improve the quality of care for the elderly. Elderly patients often develop complicated and multifactorial health states that require extensive pharmacotherapy, leaving this population at risk for exposure to drug-drug interactions and other adverse events. Previous literature supports an association between an increase in the rate of adverse events as the number of drugs taken by a patient increases.
We sought to evaluate the prevalence of polypharmacy, and to determine patient characteristics that are predictive of exposure to polypharmacy, in the elderly population of the Emilia-Romagna region in Italy.
We conducted a retrospective cohort study of the 2007 Emilia-Romagna outpatient pharmacy database linked with patient information available from a demographic file of approximately 1 million Emilia-Romagna residents aged ≥65 years. The cohort comprised 887,165 elderly subjects who had at least one prescription filled during the study year. Using the WHO's defined daily dose (DDD) to determine the duration of treatment for a given drug, we defined a polypharmacy episode as overlapping treatment with five or more medications occurring for at least 1 day. The prevalence of polypharmacy was measured together with subject characteristics found to be predictive of polypharmacy exposure.
A total of 349,689 elderly people in the population (39.4%) were exposed to at least one episode of polypharmacy during the study period. The prevalence of polypharmacy substantially increased with age and with a higher number of chronic conditions. Over 35% of those exposed to polypharmacy were exposed for 101 or more days of the year. The top three classes of medications involved in polypharmacy were antithrombotics, peptic ulcer disease and gastro-oesophageal reflux disease agents, and ACE inhibitors. The odds of exposure to polypharmacy were higher for older subjects, males and subjects living in urban areas.
This study provides evidence that the prevalence of polypharmacy in the elderly in Emilia-Romagna is substantial. Educational programmes should be developed to inform clinicians about the magnitude of the polypharmacy phenomenon and the patient characteristics associated with polypharmacy. Raising physicians' awareness of polypharmacy may help to ensure safe, effective and appropriate use of medication in the elderly.
同时服用多种药物的现象被称为多重用药，这种现象已被充分记录，并引起了人们对改善老年人医疗服务质量的关注。老年患者常常患有复杂的、多因素的健康问题，需要广泛的药物治疗，这使他们面临药物-药物相互作用和其他不良事件的风险。先前的文献表明，随着患者服用药物数量的增加，不良事件的发生率也会增加。
我们旨在评估意大利艾米利亚-罗马涅地区老年人群中多重用药的流行率，并确定与多重用药相关的患者特征。
我们对 2007 年艾米利亚-罗马涅地区门诊药房数据库进行了回顾性队列研究，并将患者信息与大约 100 万艾米利亚-罗马涅地区≥65 岁居民的人口统计文件中的信息进行了关联。该队列包括 887165 名老年患者，他们在研究年内至少有一次处方。我们使用世界卫生组织（WHO）定义的日剂量（DDD）来确定特定药物的治疗持续时间，将重叠治疗 5 种或更多药物持续至少 1 天的情况定义为多重用药。我们测量了多重用药的流行率以及与多重用药暴露相关的预测患者特征。
在该人群中，共有 349689 名老年人（39.4%）在研究期间至少经历过一次多重用药。随着年龄的增长和慢性疾病数量的增加，多重用药的发生率显著增加。超过 35%的多重用药患者每年有 101 天或更多的时间暴露于多重用药。涉及多重用药的前三大药物类别为抗血栓药、消化性溃疡病和胃食管反流病药物以及血管紧张素转换酶抑制剂。暴露于多重用药的可能性随着年龄的增长、男性和居住在城市地区的患者而增加。
本研究表明，艾米利亚-罗马涅地区老年人的多重用药流行率很高。应制定教育计划，让临床医生了解多重用药现象的严重程度以及与多重用药相关的患者特征。提高医生对多重用药的认识，可能有助于确保老年人安全、有效和合理地使用药物。
