Department of Geriatric Medicine, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
Mater Misericordiae University Hospital, Dublin, Ireland.
Age Ageing. 2015 Jul;44(4):704-8. doi: 10.1093/ageing/afv028. Epub 2015 Mar 10.
deprescribing habits among physicians managing older, frailer, cognitively impaired patients have not been well investigated.
an anonymised electronic survey was disseminated to all members of an international geriatric society/local advanced trainee network (N = 930). This comprised a Likert-scale analysis of factors influencing desprescribing, and five case vignettes, detailing a patient with progressive cognitive impairment and dependency, on a background of ischaemic heart disease and hypertension.
among 134 respondents (response rate 14.4%), 47.4% were female, 48.9% aged 36-50 years and 84.1% specialists (15.9% trainees). Respondents commonly rated limited life expectancy (96.2%) and cognitive impairment (84.1%) as very/extremely important to deprescribing practices. On multivariable analysis, older respondents less commonly rated functional dependency (odds ratio [OR] 0.22 per change in age category; P < 0.001) and limited life expectancy (OR 0.09, P = 0.04) important when deprescribing, while female participants (OR 3.03, P < 0.001) and trainees (versus specialists OR 14.29, P < 0.001) more often rated adherence to evidence-based guidelines important. As vignettes described increasing dependency and cognitive impairment, physicians were more likely to stop donepezil, aspirin, atorvastatin and antihypertensives (all P < 0.001 for trend). Aspirin (93.6%) and ramipril (94.1%) were most commonly deprescribed. Commonest reasons cited for deprescribing medications were 'dementia severity', followed by pill burden.
in this exploratory analysis, geriatricians rated limited life expectancy and cognitive impairment very important in driving deprescribing practices. Geriatricians more often deprescribed multiple medications in the setting of advancing dependency and cognitive impairment, driven by dementia severity and pill burden concerns. Physician characteristics also influence deprescribing practices. Further exploration of factors influencing deprescribing patterns, and patient outcomes, is needed.
在管理老年、体弱、认知障碍患者的医生中，减药习惯尚未得到充分研究。
一项匿名电子调查分发给国际老年医学学会/当地高级受训者网络的所有成员（N=930）。该调查包括对影响减药的因素进行李克特量表分析，以及五个案例描述，详细说明了一位患有进行性认知障碍和依赖的患者，其背景为缺血性心脏病和高血压。
在 134 名回答者中（回应率为 14.4%），47.4%为女性，48.9%年龄在 36-50 岁之间，84.1%为专家（15.9%为受训者）。受访者普遍认为预期寿命有限（96.2%）和认知障碍（84.1%）对减药实践非常/极其重要。在多变量分析中，年龄较大的受访者不太可能认为功能依赖（每改变一个年龄类别，比值比[OR]为 0.22；P<0.001）和预期寿命有限（OR 0.09，P=0.04）重要，而女性参与者（OR 3.03，P<0.001）和受训者（与专家相比，OR 14.29，P<0.001）更经常认为遵循基于证据的指南很重要。随着案例描述了依赖性和认知障碍的增加，医生更有可能停止使用多奈哌齐、阿司匹林、阿托伐他汀和降压药（所有趋势 P<0.001）。阿司匹林（93.6%）和雷米普利（94.1%）最常被减药。最常被引用的减药药物的原因是“痴呆严重程度”，其次是药物负担。
在这项探索性分析中，老年医学专家认为预期寿命有限和认知障碍在推动减药实践方面非常重要。老年医生在依赖和认知障碍加重的情况下，更经常地减药多种药物，这是由痴呆严重程度和药物负担引起的。医生的特征也会影响减药习惯。需要进一步探索影响减药模式和患者结局的因素。
