Lu Wan-Hsuan, Wen Yu-Wen, Chen Liang-Kung, Hsiao Fei-Yuan
Graduate Institute of Clinical Pharmacy (Lu, Hsiao), College of Medicine, National Taiwan University, Taipei, Taiwan; Clinical Informatics and Medical Statistics Research Center (Wen), Chang Gung University, Taoyuan, Taiwan; Aging and Health Research Center (Chen), National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology (Chen), Taipei Veterans General Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine (Hsiao), National Taiwan University, Taipei, Taiwan; Department of Pharmacy (Hsiao), National Taiwan University Hospital, Taipei, Taiwan.
Graduate Institute of Clinical Pharmacy (Lu, Hsiao), College of Medicine, National Taiwan University, Taipei, Taiwan; Clinical Informatics and Medical Statistics Research Center (Wen), Chang Gung University, Taoyuan, Taiwan; Aging and Health Research Center (Chen), National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology (Chen), Taipei Veterans General Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine (Hsiao), National Taiwan University, Taipei, Taiwan; Department of Pharmacy (Hsiao), National Taiwan University Hospital, Taipei, Taiwan
CMAJ. 2015 Mar 3;187(4):E130-E137. doi: 10.1503/cmaj.141219. Epub 2015 Feb 2.
Polypharmacy, potentially inappropriate medications and anticholinergic burden (as assessed by the anticholinergic risk scale) are commonly used as quality indicators of pharmacotherapy in older adults. However, their role in clinical practice is undefined. We sought to investigate longitudinal changes in these indicators and their effects on clinical outcomes.
We used Taiwan's Longitudinal Health Insurance Database to retrieve quarterly information about drug use for people aged 65 years and older over a 10-year period. We analyzed the association between indicators and all-cause admission to hospital, fracture-specific admission to hospital and death using generalized estimating equations.
The study cohort comprised 59,042 older adults (65-74 yr: 39,358 [66.7%], 75-84 yr: 16,903 [28.6%], and ≥ 85 yr: 2781 [4.7%]). The mean changes in polypharmacy over the course of the study were greatest among patients aged 65-74 years (absolute difference +2.14, 95% confidence interval [CI] 2.10-2.19), then among those aged 75-84 yr (+1.79, 95% CI 1.70-1.88), and finally those aged 85 years and older (+0.71, 95% CI 0.36-1.05). The number of potentially inappropriate medications increased among patients aged 65-74 years (+0.16 [0.15-0.18]) and 75-84 years (+0.09 [0.06-0.08]), but decreased in those aged 85 years and older (-0.15 [-0.26 to -0.04]). Polypharmacy, potentially inappropriate medications and anticholinergic risk scale were each associated with an increased risk of admission to hospital, but not with death. In addition, both polypharmacy (5-9 drugs: odds ratio [OR] 1.18, 95% CI 1.12-1.24; ≥ 10 drugs: OR 1.54, 95% CI 1.42-1.66) and anticholinergic burden (score 1-2: 1.39, 95% CI 1.31-1.48; ≥ 3: 1.53, 95% CI 1.41-1.66) showed dose-response relations with fracture-specific admission to hospital.
The total number of drugs taken (polypharmacy), number of potentially inappropriate medications and anticholinergic risk changed during follow-up and varied across age groups in this cohort of older adult patients. These indicators showed dose-response relations with admission to hospital, but not with death.
多重用药、潜在不适当用药以及抗胆碱能负担（通过抗胆碱能风险量表评估）通常被用作老年人药物治疗的质量指标。然而，它们在临床实践中的作用尚不明确。我们试图研究这些指标的纵向变化及其对临床结局的影响。
我们利用台湾纵向健康保险数据库，检索了10年间65岁及以上人群的季度用药信息。我们使用广义估计方程分析了这些指标与全因住院、骨折特异性住院和死亡之间的关联。
研究队列包括59042名老年人（65 - 74岁：39358人[66.7%]，75 - 84岁：16903人[28.6%]，≥85岁：2781人[4.7%]）。在研究过程中，多重用药的平均变化在65 - 74岁患者中最大（绝对差异 +2.14，95%置信区间[CI] 2.10 - 2.19），其次是75 - 84岁患者（+1.79，95% CI 1.70 - 1.88），最后是85岁及以上患者（+0.71，95% CI 0.36 - 1.05）。65 - 74岁患者（+0.16 [0.15 - 0.18]）和75 - 84岁患者（+0.09 [0.06 - 0.08]）中潜在不适当用药的数量增加，但85岁及以上患者中则减少（-0.15 [-0.26至-0.04]）。多重用药、潜在不适当用药和抗胆碱能风险量表均与住院风险增加相关，但与死亡无关。此外，多重用药（5 - 9种药物：比值比[OR] 1.18，9
