Centro Medicina dell'Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy.
Alzheimers Dement. 2013 Sep;9(5):587-93. doi: 10.1016/j.jalz.2012.09.009. Epub 2012 Dec 8.
Pharmacological treatment of older adults with cognitive impairment represents a challenge for prescribing physicians, and polypharmacy is common in these complex patients. The aim of the current study is to assess prevalence and factors related to polypharmacy in a sample of nursing home (nursing home) residents with advanced cognitive impairment.
We conducted a cross-sectional analysis of 1449 nursing home residents with advanced cognitive impairment participating to the Services and Health for Elderly in Long Term Care (SHELTER) project, a study collecting information on residents admitted to 57 nursing home in eight countries. Data were collected using the International Resident Assessment Instrument (InterRAI) for long-term care facilities. Polypharmacy status was categorized into three groups: nonpolypharmacy (zero to four drugs), polypharmacy (five to nine drugs), and excessive polypharmacy (≥10 drugs).
Polypharmacy was observed in 735 residents (50.7%) and excessive polypharmacy was seen in 245 (16.9%). Compared with nonpolypharmacy, excessive polypharmacy was associated directly with ischemic heart disease (odds ratio [OR], 3.68; 95% confidence interval [CI], 2.01-6.74), diabetes mellitus (OR, 2.66; 95% CI; 1.46-4.84), Parkinson's disease (OR, 2.84; 95% CI, 1.36-5.85), gastrointestinal symptoms (OR, 1.20; 95% CI, 1.43-3.39), pain (OR, 3.12; 95% CI, 1.99-4.89), dyspnea (OR, 2.57; 95% CI, 1.31-5.07), and recent hospitalization (OR, 2.56; 95% CI, 1.36-5.85). An inverse relation with excessive polypharmacy was shown for age (OR, 0.74; 95% CI, 0.59-0.93), activities of daily living disability (OR, 0.79; 95% CI, 0.63-0.99) and presence of a geriatrician on the nursing home staff (OR, 0.36; 95% CI, 0.20-0.64).
Polypharmacy and excessive polypharmacy are common among nursing home residents with advanced cognitive impairment. Determinants of polypharmacy status includes not only comorbidities, but also specific symptoms, age, and functional status. A geriatrician in the facility is associated with lower prevalence of excessive polypharmacy.
治疗认知障碍老年人的药物治疗对处方医生来说是一个挑战，并且这些复杂患者中常常存在多种药物治疗。本研究的目的是评估患有晚期认知障碍的疗养院（疗养院）居民中，多种药物治疗的流行情况及其相关因素。
我们对参加服务和健康老龄化长期护理（SHELTER）项目的 1449 名患有晚期认知障碍的疗养院居民进行了横断面分析，该研究收集了 8 个国家 57 家疗养院居民的信息。数据使用国际居民评估工具（InterRAI）收集。多种药物治疗状态分为三组：非多种药物治疗（0 至 4 种药物）、多种药物治疗（5 至 9 种药物）和过度多种药物治疗（≥10 种药物）。
735 名居民（50.7%）存在多种药物治疗，245 名居民（16.9%）存在过度多种药物治疗。与非多种药物治疗相比，过度多种药物治疗与缺血性心脏病（优势比 [OR]，3.68；95%置信区间 [CI]，2.01-6.74）、糖尿病（OR，2.66；95% CI，1.46-4.84）、帕金森病（OR，2.84；95% CI，1.36-5.85）、胃肠道症状（OR，1.20；95% CI，1.43-3.39）、疼痛（OR，3.12；95% CI，1.99-4.89）、呼吸困难（OR，2.57；95% CI，1.31-5.07）和最近住院（OR，2.56；95% CI，1.36-5.85）直接相关。年龄（OR，0.74；95% CI，0.59-0.93）、日常生活活动能力障碍（OR，0.79；95% CI，0.63-0.99）和疗养院工作人员中是否有老年病医生（OR，0.36；95% CI，0.20-0.64）与过度多种药物治疗呈负相关。
患有晚期认知障碍的疗养院居民中，多种药物治疗和过度多种药物治疗很常见。多种药物治疗状态的决定因素不仅包括合并症，还包括特定症状、年龄和功能状态。疗养院中有老年病医生与过度多种药物治疗的患病率较低有关。
