Thorpe Joshua M, Thorpe Carolyn T, Kennelty Korey A, Gellad Walid F, Schulz Richard
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Am J Geriatr Pharmacother. 2012 Aug;10(4):230-41. doi: 10.1016/j.amjopharm.2012.05.001. Epub 2012 Jun 9.
The risk of potentially inappropriate medication (PIM), both prescription and over-the-counter, use in dementia patients is high. Informal caregivers often facilitate patients' use of medications, but the effect of caregiver factors on PIM use has not been a focus of previous research.
The aim of this study was to examine PIM use in dementia patients and caregivers and identify caregiver risk factors for PIM use in dementia patients.
We conducted a secondary data analysis of the baseline wave of the Resources for Enhancing Alzheimer's Caregiver's Health study. The sample comprised 566 persons with dementia aged 65 and older and their coresiding family caregiver. PIM was defined using the 2003 Beers criteria and was examined in both dementia patients and their caregivers. Caregiver and patient risk factors included a range of sociodemographic and health variables.
In dementia patients, 33% were taking at least 1 PIM, and 39% of their caregivers were also taking a PIM. In fully adjusted models, the following caregiver factors were associated with an increased risk of dementia patient PIM use: caregiver's own PIM use, spouse caregivers, Hispanic caregivers, and greater number of years that the caregiver has lived in the United States. Increased caregiver age was associated with a decreased risk of PIM use in patients.
PIM use may be higher in dementia patients and their informal caregivers compared with the general older adult population. Further, patterns of medication use in 1 member of the dyad may influence PIM risk in the other dyad member. These results suggest that interventions to increase appropriate medication use in dementia patients and their caregivers should target both members of the dyad and target over-the-counter agents along with prescription medications.
痴呆症患者使用潜在不适当药物（包括处方药和非处方药）的风险很高。非正式护理人员常常协助患者用药，但护理人员因素对潜在不适当药物使用的影响尚未成为以往研究的重点。
本研究旨在调查痴呆症患者及其护理人员使用潜在不适当药物的情况，并确定痴呆症患者使用潜在不适当药物的护理人员风险因素。
我们对增强阿尔茨海默病护理人员健康资源研究的基线数据进行了二次分析。样本包括566名65岁及以上的痴呆症患者及其同住的家庭护理人员。采用2003年《Beers标准》定义潜在不适当药物，并在痴呆症患者及其护理人员中进行调查。护理人员和患者的风险因素包括一系列社会人口统计学和健康变量。
在痴呆症患者中，33%的患者至少使用1种潜在不适当药物，其护理人员中有39%也在使用潜在不适当药物。在完全调整模型中，以下护理人员因素与痴呆症患者使用潜在不适当药物的风险增加相关：护理人员自身使用潜在不适当药物、配偶护理人员、西班牙裔护理人员以及护理人员在美国居住的年限增加。护理人员年龄增加与患者使用潜在不适当药物的风险降低相关。
与一般老年人群相比，痴呆症患者及其非正式护理人员使用潜在不适当药物的情况可能更多。此外，二元组中一方的用药模式可能会影响另一方使用潜在不适当药物的风险。这些结果表明，旨在增加痴呆症患者及其护理人员合理用药的干预措施应针对二元组双方，并同时针对非处方药和处方药。
