Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
Drugs Aging. 2013 Jan;30(1):39-49. doi: 10.1007/s40266-012-0039-7.
Older individuals often suffer from multiple co-morbidities and are particularly vulnerable to potentially inappropriate prescribing (PIP). One method of defining instances of PIP is to use validated, evidence-based, explicit criteria. Two sets of criteria have gained international recognition: the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Beers' criteria.
The study aims were to (1) determine the prevalence of PIP in older residents residing in long-term care (LTC) facilities in the greater Cork region of Ireland using these tools; (2) assess the applicability of the STOPP and Beers' criteria and compare the prevalence of PIP determined by each set of criteria; and (3) investigate the association between the occurrence of PIP determined by both tools and the number of medications prescribed, age, sex and Charlson Comorbidity Index (CCI) score.
All 15 publically funded LTC facilities in the greater Cork region of Ireland were approached, and 14 agreed to participate. Residents aged ≥65 years were included. Exclusion criteria included terminally ill residents or residents receiving respite care. The prevalence of PIP was determined by applying the STOPP and Beers' criteria to each resident's medication profile. Two multivariate logistic regression models examined the association between the occurrence of PIP as determined by STOPP criteria and by Beers' criteria and the number of drugs prescribed, age, sex and CCI score.
The sample population in this study included 732 residents from 14 LTC facilities; the median age was 85 years (interquartile range [IQR] 79-89) and 514 residents (70.2 %) were female. The total number of medications prescribed was 8,325 (median 11, IQR 9-14; range 2-25). At least one instance of PIP was experienced by approximately 70 % of patients when evaluated using the STOPP criteria, while the corresponding figure was 53.4 % using Beers' criteria. STOPP identified 1,280 instances of PIP relating to 1,140 potentially inappropriate medications (PIMs), while Beers' criteria identified 833 instances of PIP relating to 704 PIMs. Multivariate regression analysis, taking age, sex, disease burden and number of medications into consideration, showed a significant positive association between the number of medications and PIP as defined by STOPP (odds ratio [OR] 1.295, 95% CI 1.223, 1.372; p < 0.001) and Beers' criteria (OR 1.263, 95% CI 1.201, 1.327; p < 0.001). Significant negative associations were also found between CCI score and the occurrence of PIP as defined by STOPP (OR 0.857, 95% CI 0.760, 0.966; p < 0.05) and the occurrence of PIP as defined by the Beers criteria (OR 0.843, 95% CI 0.754, 0.943; p < 0.05).
In this LTC population, STOPP criteria identified a higher percentage of PIMs and a higher prevalence of PIP than the Beers criteria. The higher prevalence of PIP determined using the STOPP criteria is of uncertain relevance, but may be because STOPP was designed and validated for use in an Irish setting.
老年人常患有多种合并症，特别容易出现潜在不适当的处方（PIP）。定义 PIP 实例的一种方法是使用经过验证的、基于证据的、明确的标准。有两套标准得到了国际认可：老年人潜在不适当处方筛查工具（STOPP）和 Beers 标准。
本研究旨在：（1）使用这些工具确定爱尔兰科克大区长期护理（LTC）机构中老年人的 PIP 患病率；（2）评估 STOPP 和 Beers 标准的适用性，并比较每一组标准确定的 PIP 患病率；（3）调查由两种工具确定的 PIP 的发生与所开药物数量、年龄、性别和 Charlson 合并症指数（CCI）评分之间的关系。
所有 15 家位于科克大区的公立 LTC 机构都被邀请参加，其中 14 家同意参与。年龄≥65 岁的居民被纳入研究。排除标准包括临终患者或接受临时护理的患者。通过将 STOPP 和 Beers 标准应用于每位居民的药物治疗方案，确定 PIP 的患病率。采用两种多元逻辑回归模型，分析 STOPP 标准和 Beers 标准所确定的 PIP 发生情况与所开药物数量、年龄、性别和 CCI 评分之间的关系。
本研究的样本人群包括来自 14 家 LTC 机构的 732 名居民；中位年龄为 85 岁（四分位间距 [IQR] 79-89），514 名居民（70.2%）为女性。所开药物总数为 8325 种（中位数 11，IQR 9-14；范围 2-25）。当使用 STOPP 标准评估时，约 70%的患者存在至少一例 PIP，而使用 Beers 标准时，这一比例为 53.4%。STOPP 确定了 1280 例与 1140 种潜在不适当药物（PIM）相关的 PIP，而 Beers 标准确定了 833 例与 704 种 PIM 相关的 PIP。多变量回归分析考虑了年龄、性别、疾病负担和用药数量，结果显示，药物数量与 STOPP（优势比 [OR] 1.295，95%可信区间 [CI] 1.223，1.372；p<0.001）和 Beers 标准（OR 1.263，95%CI 1.201，1.327；p<0.001）确定的 PIP 之间存在显著正相关。CCI 评分与 STOPP（OR 0.857，95%CI 0.760，0.966；p<0.05）和 Beers 标准（OR 0.843，95%CI 0.754，0.943；p<0.05）确定的 PIP 发生之间也存在显著负相关。
在本 LTC 人群中，STOPP 标准确定的 PIM 和 PIP 发生率均高于 Beers 标准。使用 STOPP 标准确定的 PIP 发生率较高的原因尚不确定，但可能是因为 STOPP 是为在爱尔兰环境中使用而设计和验证的。
