Geriatric Medicine Fellowship Program, St. Luke's Hospital/University of Toledo, OH 43537, USA.
Clin Geriatr Med. 2012 May;28(2):323-41. doi: 10.1016/j.cger.2012.01.011.
The reduction in polypharmacy and avoidance of inappropriate medications is a common goal in the care of older persons, regardless of setting. While multidisciplinary teams and regular medication reconciliation and review can identify and reduce medication-related problems, tools to decrease the use of high-risk/low benefit medications can help the individual clinician to improve prescribing. Numerous criteria, tools, algorithms, and scoring systems have been developed for use in a wide range of areas from long-term care to the outpatient setting, and some may not be applicable to individual situations. Not all medication review instruments have been adequately validated, and the tools we have presented have varying levels of evidence to support their use. Clinicians also need to be aware of regulatory, policy, and guideline issues that may impact the use of certain criteria for optimum prescribing. Ultimately, optimizing prescribing by reducing polypharmacy and avoiding inappropriate medications is a highly individualized process for each patient, and clinicians will have to use extensive clinical judgment in using the tools presented here.
减少多种药物并用和避免使用不适当的药物是无论在何种环境下照顾老年人的共同目标。多学科团队以及定期的药物重整和审查可以识别和减少与药物相关的问题，但减少使用高风险/低效益药物的工具可以帮助临床医生改善处方。已经开发了许多标准、工具、算法和评分系统，用于从长期护理到门诊环境等广泛的领域，其中一些可能不适用于个别情况。并非所有药物审查工具都经过充分验证，我们提出的工具的使用依据的证据水平也不同。临床医生还需要了解可能影响最佳处方使用某些标准的监管、政策和指南问题。最终，通过减少多种药物并用和避免使用不适当的药物来优化处方是一个高度个体化的过程，临床医生在使用这里提出的工具时必须运用广泛的临床判断。
