Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy; School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
J Am Med Dir Assoc. 2014 Jun;15(6):410-5. doi: 10.1016/j.jamda.2013.12.085. Epub 2014 Feb 20.
Despite being the highest group of users of many medications, older individuals remain underrepresented in clinical trials. This leaves a gap in evidence to guide management of many conditions, such as ischemic heart disease (IHD), in this population. This study aimed to describe factors associated with IHD medication use among nursing home residents in 7 European countries and Israel to depict challenges facing disease management in this population.
This study was a retrospective cohort analysis.
The sample included 4156 nursing home residents in the SHELTER study.
All residents were assessed using the interRAI Long-Term Care Facility (LTCF) instrument. Use of angiotensin-converting enzyme inhibitor (ACEi) and/or angiotensin receptor blocker (ARB), beta-blocker (BB), antiaggregants (including acetylsalicylic acid [ASA]) and statins was analyzed. Based on the use of these medications, residents were classified into groups by medication use (as nonusers, 1-2 medications, or 3-4 medications). Generalized Estimation Equation modeling was used to explore predictors of medication use from items on the LTCF instrument as well as facility questionnaire.
Of the 1050 residents with IHD, medication use was 77.7% overall, but only 16.9% were receiving 3 to 4 medications. Use of antiaggregants was highest at 51.7% and variations in medication use were observed by country (highest in France and lowest in Italy). Functional disability was the strongest predictor of medication use, reducing the likelihood of any or optimal management. Severe cognitive impairment also reduced the likelihood of optimal management, and comorbidity generally increased the likelihood of medication use. Polypharmacy reduced the likelihood of use of 3 to 4 medications for IHD.
Optimal management of IHD in nursing home residents was low and varied by country. Individual characteristics seemed to predict IHD medication use, suggesting prescribing bias and an effect of population differences from clinical trial cohorts.
尽管许多药物的使用者中老年人比例最高，但他们在临床试验中的代表性仍然不足。这导致在许多情况下缺乏证据来指导该人群的管理，例如缺血性心脏病（IHD）。本研究旨在描述 7 个欧洲国家和以色列的养老院居民中与 IHD 药物使用相关的因素，以描绘该人群疾病管理面临的挑战。
这是一项回顾性队列分析。
该样本包括 SHELTER 研究中的 4156 名养老院居民。
所有居民均使用 interRAI 长期护理机构（LTCF）工具进行评估。分析使用血管紧张素转换酶抑制剂（ACEi）和/或血管紧张素受体阻滞剂（ARB）、β受体阻滞剂（BB）、抗血小板药物（包括乙酰水杨酸[ASA]）和他汀类药物的情况。根据这些药物的使用情况，根据药物使用情况（非使用者、使用 1-2 种药物或使用 3-4 种药物）将居民分类。使用广义估计方程模型从 LTCF 仪器和设施问卷中的项目中探索药物使用的预测因素。
在 1050 名患有 IHD 的居民中，总体药物使用率为 77.7%，但只有 16.9%的人使用 3 至 4 种药物。抗血小板药物使用率最高，为 51.7%，药物使用情况因国家而异（法国最高，意大利最低）。功能障碍是药物使用的最强预测因素，降低了任何或最佳管理的可能性。严重认知障碍也降低了最佳管理的可能性，而合并症通常增加了药物使用的可能性。多种药物治疗降低了使用 3 至 4 种药物治疗 IHD 的可能性。
养老院居民 IHD 的最佳管理水平较低，且因国家而异。个体特征似乎可以预测 IHD 药物的使用，这表明存在处方偏见，以及临床试验队列人群差异的影响。
