Strehblow Christoph, Smeikal Michael, Fasching Peter
5th Medical Department,, Wilhelminenspital, Montleartstr. 37, 1160, Vienna, Austria,
Wien Klin Wochenschr. 2014 Apr;126(7-8):195-200. doi: 10.1007/s00508-013-0485-1. Epub 2014 Jan 21.
The aim of this study was to assess the occurrence of polypharmacy and excessive polypharmacy in very old hospitalized patients based on their comorbidities.
The documentation of patients aged 80 years or older admitted to our department in the year 2010 was analyzed. Based on the Charlson index of comorbidity, a multiple logistic regression model with stepwise backward elimination was performed. Patients were stratified by gender and four age-groups, and factors of a change in the number of medications during the hospital stay were assessed.
Chronic pulmonary disease [odds ratio (OR): 2.40], diabetes mellitus with (OR: 4.65) or without (OR: 1.65) microvascular complications, congestive heart failure (OR: 2.37), connective tissue disease (OR: 3.02), and peripheral vascular disease (OR: 2.30) were statistically significantly associated with polypharmacy, while some of these diseases were also associated with excessive polypharmacy. The number of medications showed a gradual decrease with age, which was concordant with a decrease in total Charlson index score. "Admission for myocardial infarction" was associated with an increase in pharmaceuticals during hospital stay, whereas a known diagnosis of dementia or metastatic malignant disease was protective against a further increase in medications.
Several medical conditions seem to predispose to polypharmacy in very old patients. To attain old age seems to be associated with few comorbidities, which reduces the need for a high number of pharmaceuticals. Physicians should pay attention to the identified predictors in very old patients, as polypharmacy may lead to adverse events and unnecessary hospitalization.
本研究旨在根据老年住院患者的合并症评估多重用药及过度多重用药的发生情况。
对2010年入住我科的80岁及以上患者的病历进行分析。基于查尔森合并症指数，采用逐步向后排除法进行多重逻辑回归模型分析。患者按性别和四个年龄组进行分层，并评估住院期间用药数量变化的因素。
慢性肺病[比值比（OR）：2.40]、伴有（OR：4.65）或不伴有（OR：1.65）微血管并发症的糖尿病、充血性心力衰竭（OR：2.37）、结缔组织病（OR：3.02）和外周血管疾病（OR：2.30）与多重用药在统计学上显著相关，而其中一些疾病也与过度多重用药相关。用药数量随年龄逐渐减少，这与查尔森指数总分的降低一致。“因心肌梗死入院”与住院期间用药增加相关，而已知的痴呆或转移性恶性疾病诊断可防止用药进一步增加。
几种疾病状况似乎使老年患者易发生多重用药。高龄似乎与较少的合并症相关，这减少了大量用药的需求。医生应关注老年患者中已确定的预测因素，因为多重用药可能导致不良事件和不必要的住院治疗。
