Centro Medicina dell'Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy.
J Am Med Dir Assoc. 2013 Jun;14(6):450.e7-12. doi: 10.1016/j.jamda.2013.03.014. Epub 2013 May 4.
Older adults with advanced cognitive impairment have a limited life expectancy and the use of multiple drugs is of questionable benefit in this population. The aim of the present study was to assess if, in a sample of nursing home (NH) residents with advanced cognitive impairment, the effect of polypharmacy on mortality differs depending on estimated life expectancy.
Data were from the Services and Health for Elderly in Long TERm care (SHELTER) project, a study collecting information on residents admitted to 57 NHs in 8 European countries. Polypharmacy was defined as the concomitant use of 10 or more drugs. Limited life expectancy was estimated based on an Advanced Dementia Prognostic Tool (ADEPT) score of 13.5 or more. A Cognitive Performance Scale score of 5 or more was used to define advanced cognitive impairment. Participants were followed for 1 year.
Mean age of 822 residents with advanced cognitive impairment entering the study was 84.6 (SD 8.0) years, and 630 (86.6%) were women. Overall, 123 participants (15.0%) had an ADEPT score of 13.5 or more (indicating limited life expectancy) and 114 (13.9%) were on polypharmacy. Relative to residents with ADEPT score less than 13.5, those with ADEPT score of 13.5 or higher had a lower use of benzodiazepines, antidementia drugs, and statins but a higher use of beta-blockers, digoxin, and antibiotics. Polypharmacy was associated with increased mortality among residents with ADEPT score of 13.5 or more (adjusted hazard ratio [HR] 2.19, 95% confidence interval [CI]: 1.15-4.17), but not among those with ADEPT score less than 13.5 (adjusted HR 1.10, 95% CI: 0.71-1.71).
Polypharmacy is associated with increased mortality in NH residents with advanced cognitive impairment at the end of life.
These findings underline the need to assess life expectancy in older adults to improve the prescribing process and to simplify drug regimens.
患有晚期认知障碍的老年人预期寿命有限，且在该人群中使用多种药物的获益值得怀疑。本研究的目的是评估在患有晚期认知障碍的养老院（NH）居民样本中，多药治疗对死亡率的影响是否因预期寿命的不同而有所不同。
数据来自 Services and Health for Elderly in Long TERm care（SHELTER）项目，该项目收集了 8 个欧洲国家 57 家 NH 入住居民的信息。多药治疗定义为同时使用 10 种或更多药物。根据高级痴呆预后工具（ADEPT）评分 13.5 或更高来估计有限的预期寿命。认知表现量表评分为 5 或更高被定义为晚期认知障碍。参与者随访 1 年。
纳入研究的 822 名患有晚期认知障碍的居民的平均年龄为 84.6（8.0）岁，其中 630 名（86.6%）为女性。总体而言，123 名参与者（15.0%）的 ADEPT 评分为 13.5 或更高（表明预期寿命有限），114 名（13.9%）服用了多种药物。与 ADEPT 评分低于 13.5 的居民相比，ADEPT 评分等于或高于 13.5 的居民使用苯二氮䓬类药物、抗痴呆药物和他汀类药物的比例较低，而使用β受体阻滞剂、地高辛和抗生素的比例较高。在 ADEPT 评分等于或高于 13.5 的居民中，多药治疗与死亡率增加相关（调整后的危险比[HR]2.19，95%置信区间[CI]：1.15-4.17），但在 ADEPT 评分低于 13.5 的居民中无相关性（调整后的 HR 1.10，95% CI：0.71-1.71）。
在生命末期，多药治疗与 NH 患有晚期认知障碍的居民的死亡率增加相关。
这些发现强调需要评估老年人的预期寿命，以改善处方流程并简化药物治疗方案。
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