社区居住老年人的认知障碍与用药复杂性：健康、衰老与身体成分研究
Cognitive Impairment and Medication Complexity in Community-Living Older Adults: The Health, Aging and Body Composition Study.
作者信息
Lee David Sh, de Rekeneire Nathalie, Hanlon Joseph T, Gill Thomas M, Bauer Douglas C, Meibohm Bernd, Harris Tamara B, Jeffery Sean M
机构信息
Section of Geriatrics, School of Medicine, Yale University, New Haven, CT; now, Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR.
Section of Geriatrics, School of Medicine, Yale University;
出版信息
J Pharm Technol. 2012 Jul 1;28(4):156-162. doi: 10.1177/875512251202800405.
BACKGROUND
Medication complexity is a large determinant of adherence. Few studies have explored the relationship between cognitive impairment and medication complexity.
OBJECTIVE
To evaluate whether cognitive impairment is associated with medication complexity for prescription and over-the-counter (OTC) medications.
METHODS
In this cross-sectional analysis, we studied the association between cognitive impairment and the complexity of prescription and OTC drug regimens. Baseline participants were from the Health, Aging and Body Composition study, consisting of 3075 well-functioning 70- to 79-year-old black and white men and women. Cognitive impairment was defined by having a Modified Mini-Mental State Examination score <80. The complexity of prescription and OTC (including supplements/herbals) medications was assessed using a modified version of the Medication Regimen Complexity Index (mMRCI). The mMRCI score increases with complexity of dosage forms, number of medications, pill burden, and nondaily dosing.
RESULTS
The mean (SD) age was 74 (2.9) years (n = 3055; 52% female, 41% black). The median prescription mMRCI score was 6 (range 0-66). The median OTC mMRCI score was 4 (range 0-71). Adjusting for health status, demographics, and access to care, medication complexity was lower in participants with cognitive impairment for prescription (adjusted RR 0.89; 95% CI 0.80 to 0.99) and OTC medications (adjusted RR 0.76; 95% CI 0.64 to 0.93) compared to those without cognitive impairment. The number of prescription medications was not different, but the number of OTC drugs was lower for those with cognitive impairment.
CONCLUSIONS
In this cohort of well-functioning older adults, those with cognitive impairment had lower prescription complexity due to less-complex dosage forms, pill burden, or daily dosing. OTC complexity was also lower, primarily due to a lower number of OTC drugs. The results of this study show that further research on medication complexity and adherence and health outcomes in cognitively impaired individuals is warranted.
背景
药物治疗的复杂性是依从性的一个重要决定因素。很少有研究探讨认知障碍与药物治疗复杂性之间的关系。
目的
评估认知障碍是否与处方药和非处方药（OTC）的药物治疗复杂性相关。
方法
在这项横断面分析中，我们研究了认知障碍与处方药和非处方药治疗方案复杂性之间的关联。基线参与者来自健康、衰老和身体成分研究，包括3075名功能良好的70至79岁黑人和白人男性及女性。认知障碍的定义为改良简易精神状态检查得分<80。使用改良版药物治疗方案复杂性指数（mMRCI）评估处方药和非处方药（包括补充剂/草药）的复杂性。mMRCI得分随着剂型复杂性、药物数量、药丸负担和非每日给药情况而增加。
结果
平均（标准差）年龄为74（2.9）岁（n = 3055；52%为女性，41%为黑人）。处方药mMRCI得分中位数为6（范围0 - 66）。非处方药mMRCI得分中位数为4（范围0 - 71）。在调整健康状况、人口统计学特征和医疗服务可及性后，与无认知障碍者相比，认知障碍参与者的处方药（调整后RR 0.89；95%CI 0.80至0.99）和非处方药（调整后RR 0.76；95%CI 0.64至0.93）治疗复杂性较低。处方药数量没有差异，但认知障碍者的非处方药数量较少。
结论
在这个功能良好的老年人群队列中，认知障碍者由于剂型、药丸负担或每日给药情况较简单，其处方药复杂性较低。非处方药复杂性也较低，主要是由于非处方药数量较少。本研究结果表明，有必要对认知障碍个体的药物治疗复杂性、依从性和健康结局进行进一步研究。
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