Stock Stephanie, Redaelli Marcus, Simic Dusan, Siegel Martin, Henschel Frank
Institut für Gesundheitsökonomie und Klinische Epidemiologie der Universität zu Köln, Gleueler Str. 176-178, 50935, Köln, Germany,
Wien Klin Wochenschr. 2014 Oct;126(19-20):604-12. doi: 10.1007/s00508-014-0589-2. Epub 2014 Sep 13.
Elderly people are especially prone to suffer adverse drug reactions (ADR). Main reasons for the higher vulnerability of the elderly to ADR are changes in metabolism as i.e. slower renal clearance and polypharmacie which often results from multimorbidity. To prevent ADR careful prescription with special consideration of these aspects is warranted. To help physicians avoid drugs which are especially likely to cause ADR lists have been developed following the consensus method process. For Germany this list is called the PRISCUS list. It was developed based on a literature review, review of international lists such as the American Beers list, and a consensus process based on a Delphi survey. It contains 83 drugs from 18 classes which are classified as potentially inapropriate medication (PIM). It also lists alternatives for each PIM. If a drug is registered with the PRISCUS list this does not mean automatically that it is contraindicated in the elderly but that special caution should be excercised in prescribing the drug, alternatives should be considered and the patient carefully monitored.Prescription rates for PIMs in Germany in the elderly is pretty much stable at around 23% with only a small decline in the past years. Also, more than 5% of all prescriptions in the elderly are PIM prescriptions. Physicians specially trained in geriatrics tend to prescribe less PIMs compared to other physicians.
老年人尤其容易发生药物不良反应（ADR）。老年人对ADR易感性较高的主要原因是代谢变化，如肾脏清除率降低以及多重疾病常导致的多种药物联合使用。为预防ADR，有必要在开处方时特别考虑这些方面并谨慎用药。为帮助医生避免使用特别容易引起ADR的药物，已按照共识方法流程制定了相关清单。在德国，这份清单被称为PRISCUS清单。它是基于文献综述、对美国比尔斯清单等国际清单的审查以及基于德尔菲调查的共识流程而制定的。它包含来自18类的83种药物，这些药物被归类为潜在不适当用药（PIM）。它还列出了每种PIM的替代药物。如果一种药物被列入PRISCUS清单，这并不意味着它在老年人中自动被禁用，但在开这种药时应格外谨慎，应考虑替代药物，并对患者进行密切监测。德国老年人中PIM的处方率相当稳定，约为23%，在过去几年中仅有小幅下降。此外，老年人所有处方中超过5%是PIM处方。与其他医生相比，接受过老年医学专门培训的医生倾向于开出较少的PIM处方。
