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美国老年医学学会更新了老年人潜在不适当药物使用的 Beers 标准。

American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults.

出版信息

J Am Geriatr Soc. 2012 Apr;60(4):616-31. doi: 10.1111/j.1532-5415.2012.03923.x. Epub 2012 Feb 29.

Abstract

Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modified Delphi method to the systematic review and grading to reach consensus on the updated 2012 AGS Beers Criteria. Fifty-three medications or medication classes encompass the final updated Criteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria. Thoughtful application of the Criteria will allow for (a) closer monitoring of drug use, (b) application of real-time e-prescribing and interventions to decrease ADEs in older adults, and (c) better patient outcomes.

摘要

尽管有证据表明老年人使用潜在不适当药物(PIMs)会导致不良后果,但 PIMs 仍被继续开处方并作为最脆弱的老年人的一线治疗药物。PIMs 现在已成为政策和实践的一个组成部分,并被纳入了几项质量措施。该项目的具体目的是使用全面、系统的文献回顾和药物相关问题及老年人不良药物事件(ADEs)的证据评估,更新以前的 Beers 标准。这是通过美国老年医学会(AGS)的支持以及由 11 名老年护理和药物治疗方面的跨学科专家组成的小组完成的,他们应用改良 Delphi 方法对系统评价和分级进行评估,就更新的 2012 年 AGS Beers 标准达成共识。五十三种药物或药物类别涵盖了最终更新的标准,这些标准分为三类:老年人中应避免使用的潜在不适当药物和类别、药物列表中可加重某些疾病和综合征的老年人中应避免使用的潜在不适当药物和类别,以及老年人中应谨慎使用的药物。这次更新具有很强的优势,包括使用基于证据的方法(采用医学研究所的标准)以及建立合作伙伴关系,以定期更新标准。谨慎应用标准将有助于:(a)更密切监测药物使用,(b)实时电子处方和干预措施的应用,以减少老年人的 ADEs,以及(c)改善患者的预后。

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