老年疗养院居民中潜在不适当药物的使用及生活质量变化
The use of potentially inappropriate medications and changes in quality of life among older nursing home residents.
作者信息
Al Aqqad Saná M H, Chen Li Li, Shafie Asrul Akmal, Hassali Mohamed Azmi, Tangiisuran Balamurugan
机构信息
Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
出版信息
Clin Interv Aging. 2014 Jan 22;9:201-7. doi: 10.2147/CIA.S52356. eCollection 2014.
BACKGROUND
Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL) have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs) and the changes observed in the HRQoL among older nursing home residents.
METHODS
A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old) taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D) and EuroQol-visual analog scale (EQ-VAS) at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test.
RESULTS
The median age of the 211 participants was 77 years (interquartile range 72-82 years) and the median number of prescription medicines was four (interquartile range three to six). The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months also showed no statistically significant differences.
CONCLUSION
PIMs were found to be relatively common among older nursing home residents. However, no significant changes were observed in HRQoL among these residents. Further studies with a bigger sample size and longer follow up period are required to establish this association.
背景
养老院居民主要是患有多种疾病且服用多种药物的老年人。马来西亚尚未报道药物的合理使用及其与健康相关生活质量（HRQoL）的关联。本研究旨在调查老年养老院居民中潜在不适当药物（PIMs）的使用与HRQoL变化之间的关联。
方法
在马来西亚槟城的四家非政府组织养老院进行了一项前瞻性随访研究。纳入至少服用一种处方药的老年居民（≥65岁）。使用老年人潜在不适当处方筛查工具（STOPP）标准识别患有PIMs的居民。在基线和3个月随访后，使用欧洲五维健康量表（EQ-5D）和欧洲视觉模拟量表（EQ-VAS）评估HRQoL。使用曼-惠特尼U检验分析PIMs与HRQoL的关联。
结果
211名参与者的中位年龄为77岁（四分位间距72 - 82岁），处方药物的中位数为4种（四分位间距3 - 6种）。PIMs的患病率在基线时为23.7%，3个月后为18.6%。按降序排列，最常开具的PIMs为第一代抗组胺药、重复药物类别处方、用于2型糖尿病的格列本脲以及用于治疗抗精神病药物锥体外系副作用的抗胆碱能药物。在基线时，有或无PIMs的居民在EQ-5D、EQ-5D指数或EQ-VAS评分的每个类别中均无显著差异。基线和3个月后EQ-5D平均得分指数差异的比较也未显示出统计学显著差异。
结论
发现PIMs在老年养老院居民中相对常见。然而，这些居民的HRQoL未观察到显著变化。需要进行更大样本量和更长随访期的进一步研究来确定这种关联。
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