Aspinall Sherrie L, Zhao Xinhua, Semla Todd P, Cunningham Francesca E, Paquin Allison M, Pugh Mary Jo, Schmader Kenneth E, Stone Roslyn A, Hanlon Joseph T
Veterans Affairs Pharmacy Benefits Management Services, Hines, Illinois; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Am Geriatr Soc. 2015 Jan;63(1):77-84. doi: 10.1111/jgs.13197. Epub 2014 Dec 23.
To describe the prevalence of and factors associated with drug-disease interactions (DDIs) in older nursing home residents according to the American Geriatrics Society 2012 Beers Criteria.
Cross-sectional.
Fifteen Veterans Affairs Community Living Centers.
Individuals aged 65 and older with a diagnosis of dementia or cognitive impairment, a history of falls or hip fracture, heart failure (HF), a history of peptic ulcer disease (PUD), or Stage IV or V chronic kidney disease (CKD).
Medications that could exacerbate the above conditions (DDIs).
Three hundred sixty-one of 696 (51.9%) eligible residents had one or more DDIs. None involved residents with a history of PUD, one involved a resident with CKD, and four occurred in residents with HF. Of 540 residents with dementia or cognitive impairment, 50.7% took a drug that could exacerbate these conditions; the most commonly involved medications were antipsychotics (35.4%) and benzodiazepines (14.4%). Of 267 with a history of falls or hip fracture, 67.8% received an interacting medication, with selective serotonin reuptake inhibitors (33.1%), antipsychotics (30.7%), and anticonvulsants (25.1%) being most commonly involved. Using separate multivariable logistic regression models, factors associated with DDIs in dementia or cognitive impairment and falls or fractures included age 85 and older (adjusted odds ratio (aOR) = 0.38, 95% confidence interval (CI) = 0.24-0.60 and aOR = 0.48, 95% CI = 0.24-0.96, respectively), taking five to eight medications (aOR = 2.06, 95% CI = 1.02-4.16 and aOR = 4.76, 95% CI = 1.68-13.5, respectively), taking nine or more medications (aOR = 1.99, 95% CI = 1.03-3.85 and aOR = 3.68, 95% CI = 1.41-9.61, respectively), and being a long-stay resident (aOR = 1.80, 95% CI = 1.04-3.12 and aOR = 2.35, 95% CI = 1.12-4.91, respectively).
DDIs were common in older nursing home residents with dementia or cognitive impairment or a history of falls or fractures.
根据美国老年医学会2012年《Beers标准》，描述老年疗养院居民中药物 - 疾病相互作用（DDIs）的患病率及相关因素。
横断面研究。
15个退伍军人事务社区生活中心。
年龄在65岁及以上，患有痴呆或认知障碍、有跌倒或髋部骨折病史、心力衰竭（HF）、消化性溃疡疾病（PUD）病史或IV期或V期慢性肾脏病（CKD）的个体。
可能加重上述疾病的药物（DDIs）。
696名符合条件的居民中有361名（51.9%）存在一种或多种DDIs。没有涉及有PUD病史的居民，1例涉及有CKD的居民，4例发生在有HF的居民中。在540名患有痴呆或认知障碍的居民中，50.7%服用了可能加重这些疾病的药物；最常涉及的药物是抗精神病药（35.4%）和苯二氮䓬类药物（14.4%）。在267名有跌倒或髋部骨折病史的居民中，67.8%接受了相互作用的药物，最常涉及的是选择性5-羟色胺再摄取抑制剂（33.1%）、抗精神病药（30.7%）和抗惊厥药（25.1%）。使用单独的多变量逻辑回归模型，与痴呆或认知障碍以及跌倒或骨折中的DDIs相关的因素包括85岁及以上（调整优势比（aOR）分别为0.38，95%置信区间（CI）=0.24 - 0.60和aOR = 0.48，95% CI = 0.24 - 0.96）、服用5至8种药物（aOR分别为2.06，95% CI = 1.02 - 4.16和aOR = 4.76，95% CI = 1.68 - 13.5）、服用9种或更多药物（aOR分别为1.99，95% CI = 1.03 - 3.85和aOR = 3.68，95% CI = 1.41 - 9.61）以及长期居住居民（aOR分别为1.80，95% CI = 1.04 - 3.12和aOR = 2.35，95% CI = 1.12 - 4.91）。
DDIs在患有痴呆或认知障碍或有跌倒或骨折病史的老年疗养院居民中很常见。
