Hofer-Dückelmann Christina
Pharmacy Department, Landesapotheke am St. Johanns Spital, Salzburg, Austria.
Handb Exp Pharmacol. 2012(214):169-82. doi: 10.1007/978-3-642-30726-3_9.
Polypharmacotherapy is a major concern in the elderly and especially in older women after the age of 80. It results from the intake of prescription and non-prescription drugs, being often a problem of evidence-based therapy. Besides the fact that women live longer than men and outnumber them, reasons for polypharmacy in women are diverse and include a different attitude towards intake of drugs between men and women, the propensity of women to rather see a physician and talk about their problems, the load of family responsibility as women are the main caregivers within a family, the influence of physician sex on patient care, the level of education, social deprivation and self-rated health. Women are more often prescribed potentially inappropriate medication and more often become victims of adverse drug reactions. This is not only due to the number and quality of drugs prescribed but also to differences in pharmacokinetics and - dynamics which make them more vulnerable to drug exposure. Thus, inappropriate prescribing contributes to hospitalization, poor quality of life, costs, compliance issues and poor outcomes. More preclinical and clinical studies with elderly patients and especially elderly women are needed to study the underlying mechanisms of the pharmacologic differences and obtain more insight into the difference in risk between men and women. Attention to prescribing of medications, consistent review of medication lists, and reevaluation of indications and outcomes of prescribing are essential to ensure that drugs are used appropriately in elderly women, polypharmacy is minimized and safety for patients is maximized.
多重用药是老年人尤其是80岁以上老年女性的一个主要问题。它源于处方药和非处方药的摄入，这往往是循证治疗的一个问题。除了女性比男性寿命更长且人数更多这一事实外，女性多重用药的原因多种多样，包括男女对药物摄入的态度不同、女性更倾向于看医生并谈论自己的问题、女性作为家庭主要照顾者所承担的家庭责任负担、医生性别对患者护理的影响、教育水平、社会剥夺和自评健康状况。女性更常被开潜在不适当的药物，也更常成为药物不良反应的受害者。这不仅是由于所开药物的数量和质量，还由于药代动力学和药效学的差异，使她们更容易受到药物暴露的影响。因此，不适当的开药会导致住院、生活质量差、成本增加、依从性问题和不良后果。需要对老年患者尤其是老年女性进行更多的临床前和临床研究，以研究药理学差异的潜在机制，并更深入地了解男女之间的风险差异。关注药物处方、持续审查用药清单以及重新评估处方的适应症和结果，对于确保老年女性合理用药、尽量减少多重用药以及最大限度提高患者安全性至关重要。
