养老院患者的药物使用频度、变异性及其相关因素。
Rates, variability, and associated factors of polypharmacy in nursing home patients.
机构信息
Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel ; Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel.
Department of Geriatric Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel.
出版信息
Clin Interv Aging. 2013;8:1585-90. doi: 10.2147/CIA.S52698. Epub 2013 Nov 28.
OBJECTIVES
To determine the rate and variability of polypharmacy in nursing home (NH) residents and investigate its relationship to age, sex, functional status, length of stay, and comorbidities.
METHODS
We conducted a cross sectional, multicenter study that included six nursing homes. Demographic, clinical characteristics, Charlson comorbidity index (CCI), the number and classes of chronic medications, rate of polypharmacy >5 drugs (per day) and polypharmacy >7 drugs (per day) were recorded.
RESULTS
Nine hundred and ninety-three residents were included; 750 (75.5%) fully dependent residents and 243 (24.5%) mobile demented residents requiring institutional care. The mean age was 85.04±7.55 (65-108) years. The mean rates of polypharmacy >5 drugs and polypharmacy >7 drugs were 42.6% and 18.6%, respectively. Differences in polypharmacy >5 drugs and polypharmacy >7 drugs were observed in NHs 24.7%-56% and 4.9%-30.4%, respectively (P<0.001). Mean number of chronic drugs per resident was 5.14±2.60 from 3.81±2.24 to 5.95±2.73 (P<0.001). No differences in polypharmacy were found between sex and fully dependent versus mobile demented residents. The most common medications taken were for gastrointestinal, neurological, and cardiovascular disorders. Regression analysis revealed four independent variables for polypharmacy >5 drugs: groups aged 75-84 and >85 relative to 65-74, odds ratio (OR) 0.46 (95% confidence interval [CI] 0.27-0.78) P=0.004, OR 0.35 (95% confidence interval 0.19-0.53), respectively, P<0.001; length of stay >2 years, OR 0.51 (95% CI 0.36-0.73) P<0.001; CCI, OR 1.58 (95% CI 1.42-1.75) P<0.001; and feeding tube versus normal feeding, OR 0.27 (95% CI 0.12-0.60) P=0.001.
CONCLUSION
Rates of polypharmacy in NHs are high with significant variability. Variability rates of polypharmacy, distinct residents' characteristics, and excessive use of certain drug groups may indicate that a decrease in medication is potentially feasible.
目的
确定养老院（NH）居民的多种药物使用的发生率和变异性，并调查其与年龄、性别、功能状态、入住时间和合并症的关系。
方法
我们进行了一项横断面、多中心研究，包括六家养老院。记录了人口统计学、临床特征、Charlson 合并症指数（CCI）、慢性药物的数量和种类、每天使用>5 种药物（每剂）和每天使用>7 种药物（每剂）的发生率。
结果
共纳入 993 名居民；750 名（75.5%）完全依赖的居民和 243 名（24.5%）需要机构护理的移动痴呆居民。平均年龄为 85.04±7.55 岁（65-108）。每天使用>5 种药物和每天使用>7 种药物的平均发生率分别为 42.6%和 18.6%。NH24.7%-56%和 4.9%-30.4%之间观察到每天使用>5 种药物和每天使用>7 种药物的差异（P<0.001）。每位居民慢性药物的平均数量从 3.81±2.24 增加到 5.95±2.73（P<0.001）。性别、完全依赖与移动痴呆居民之间的药物使用无差异。最常见的药物用于胃肠道、神经和心血管疾病。回归分析显示，每天使用>5 种药物的四个独立变量为：年龄组 75-84 岁和>85 岁相对于 65-74 岁，比值比（OR）0.46（95%置信区间 [CI] 0.27-0.78）P=0.004，OR 0.35（95%置信区间 0.19-0.53），分别，P<0.001；入住时间>2 年，OR 0.51（95% CI 0.36-0.73）P<0.001；CCI，OR 1.58（95% CI 1.42-1.75）P<0.001；和喂养管与正常喂养，OR 0.27（95% CI 0.12-0.60）P=0.001。
结论
NH 中多种药物使用的发生率很高，且存在显著差异。多种药物使用的变异性、不同居民的特征和某些药物组的过度使用可能表明潜在地减少药物治疗是可行的。
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