Department of Geriatrics, University Medical Centre, Utrecht, The Netherlands.
Drugs Aging. 2011 May 1;28(5):391-402. doi: 10.2165/11587200-000000000-00000.
Elderly patients with multiple morbidities and polypharmacy are at an increased risk of adverse drug events (ADEs). Appropriate prescribing, preserving the balance between drug effectiveness and safety, and treatment adherence may prevent these ADEs. In this study, we investigated which drug properties, such as effectiveness, safety, clinical experience and convenience, are relevant to the choice of medicine most appropriate for frail elderly patients.
The primary aim of this study was to develop a set of criteria to assist in the selection of the most appropriate drug within a drug class for the treatment of frail elderly patients. A secondary goal was to test the usefulness of the set of criteria in the prescription of antipsychotics for delirium and behavioural and psychological symptoms of dementia (BPSD).
Thirty-one criteria potentially relevant to the choice of appropriate drugs for frail elderly patients were selected on the basis of a literature search in MEDLINE (1966-2008), EMBASE (1947-2008) and the Cochrane Library (1993-2008). This list was reviewed by 46 experts (24 physicians, 22 pharmacists), who scored each item for relevance in clinical practice on a scale from 1 to 10 (where 1 is not important and 10 is very important). By consensus, the authors selected the most relevant criteria for the final set of criteria. The usefulness of the final set of criteria was assessed with regard to the prescription of antipsychotics for delirium and BPSD.
The final set of 23 items consisted of 3 items on effectiveness, 14 on safety, including pharmacokinetic and pharmacodynamic criteria, 3 on clinical experience and 3 on convenience. Assessment using these criteria of the appropriateness of antipsychotics prescribed for delirium and BPSD revealed that certain drugs should be prescribed with caution to patients with Parkinson's disease and Lewy body dementia.
The criteria identified in this study, selected on the basis of a literature review and clinical expert opinion, represent a promising approach for determining the appropriateness of a drug for use in frail elderly individuals relative to alternative drugs for the same indication or from the same class.
患有多种合并症和多种药物治疗的老年患者发生药物不良事件（ADEs）的风险增加。适当的处方，在药物有效性和安全性之间保持平衡，以及治疗依从性，可能会预防这些 ADEs。在这项研究中，我们调查了哪些药物特性，如有效性、安全性、临床经验和便利性，与为体弱老年患者选择最合适的药物有关。
本研究的主要目的是制定一套标准，以协助在同一药物类别中选择最适合体弱老年患者的药物。次要目标是测试该套标准在开处方治疗谵妄和痴呆的行为和心理症状（BPSD）的抗精神病药物时的有用性。
根据 MEDLINE（1966-2008 年）、EMBASE（1947-2008 年）和 Cochrane 图书馆（1993-2008 年）的文献检索，选择了 31 项可能与为体弱老年患者选择合适药物有关的标准。该清单由 46 名专家（24 名医生，22 名药剂师）进行了审查，他们根据临床实践的相关性对每个项目进行了 1 到 10 分的评分（其中 1 分不重要，10 分非常重要）。通过共识，作者选择了与最终标准最相关的标准。最后一组标准的有用性是根据治疗谵妄和 BPSD 的抗精神病药物的处方来评估的。
最终的 23 项标准包括 3 项有效性标准，14 项安全性标准，包括药代动力学和药效学标准，3 项临床经验标准和 3 项便利性标准。使用这些标准评估为谵妄和 BPSD 开处方的抗精神病药物的适宜性表明，某些药物应谨慎开给患有帕金森病和路易体痴呆的患者。
本研究中确定的标准是基于文献回顾和临床专家意见选择的，代表了一种有前途的方法，可以确定一种药物相对于同一适应症或同一类别的其他药物在体弱个体中的适宜性。
