Department of Clinical Pharmacology, 11C Main Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
J Clin Epidemiol. 2012 Sep;65(9):989-95. doi: 10.1016/j.jclinepi.2012.02.018. Epub 2012 Jun 27.
This study aimed to determine an optimal discriminating number of concomitant medications associated with geriatric syndromes, functional outcomes, and mortality in community-dwelling older men.
Older men aged ≥ 70 years (n=1,705), enrolled in the Concord Health and Aging in Men Project were studied. Receiver operating characteristic curve analysis using the Youden Index and the area under the curve was performed to determine discriminating number of medications in relation to each outcome.
The highest value of the Youden Index for frailty was obtained for a cutoff point of 6.5 medications compared with a cutoff of 5.5 for disability and 3.5 for cognitive impairment. For mortality and incident falls, the highest value of Youden Index was obtained for a cutoff of 4.5 medications. For every one increase in number of medications, the adjusted odds ratios were 1.13 (95% confidence interval [CI]=1.06-1.21) for frailty, 1.08 (95% CI=1.00-1.15) for disability, 1.09 (95% CI=1.04-1.15) for mortality, and 1.07 (95% CI=1.03-1.12) for incident falls. There was no association between increasing number of medications and cognitive impairment.
The study supports the use of five or more medications in the current definition of polypharmacy to estimate the medication-related adverse effects for frailty, disability, mortality, and falls.
本研究旨在确定与老年综合征、功能结局和社区居住的老年男性死亡率相关的最佳伴随用药数量。
研究了年龄≥70 岁（n=1705）的参加康科德健康和老龄化男性项目的老年男性。使用约登指数和曲线下面积进行接收器工作特征曲线分析，以确定与每种结局相关的药物区分数量。
在用于残疾的 5.5 个药物和用于认知障碍的 3.5 个药物的截止值相比，用于衰弱的截止值为 6.5 个药物时，约登指数的最高值最高。对于死亡率和跌倒事件，截止值为 4.5 个药物时，约登指数的最高值最高。每增加一种药物，衰弱的调整比值比为 1.13（95%置信区间[CI]=1.06-1.21），残疾为 1.08（95%CI=1.00-1.15），死亡率为 1.09（95%CI=1.04-1.15），跌倒事件为 1.07（95%CI=1.03-1.12）。药物数量的增加与认知障碍之间没有关联。
该研究支持在当前的多药治疗定义中使用五种或更多药物来估计与衰弱、残疾、死亡率和跌倒相关的药物相关不良事件。
