City of Porvoo, Health Services, Porvoo, Finland; Department of General Practice, and Helsinki University Hospital, Unit of Primary Health Care, University of Helsinki, Finland.
Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, Carea Central Hospital Pharmacy, Kotka, Finland.
J Am Med Dir Assoc. 2016 Mar 1;17(3):276.e9-14. doi: 10.1016/j.jamda.2015.12.011. Epub 2016 Jan 21.
This study investigated the overlap among 3 different definitions of potentially harmful medication (PHM) use and the corresponding associations with resident quality of life and mortality.
Cross-sectional study with 3-year follow-up for mortality.
Assisted living facilities and nursing homes in Helsinki and Kouvola, Finland.
A total of 326 residents.
PHM use was defined as (1) use of medications with anticholinergic properties, (2) use of Beers Criteria medications, and (3) concomitant use 3 or more psychotropic medications. Health-related quality of life (HRQoL) was assessed using the 15D and psychological well-being (PWB) scale. Residents self-rated their own health using a 4-point scale. Mortality data were obtained from central registers.
There were 38.0%, 28.2%, and 12.6% of residents who used PHMs according to 1 (G1), 2 (G2), and 3 definitions (G3), respectively. Overall, 21.2% of residents did not use PHMs according to any of the 3 definitions (G0). There were no significant differences in comorbidity, cognition, or functioning among groups. In adjusted analyses, there was a stepwise association between use of multiple PHMs and poorer self-rated health, poorer PWB, and poorer HRQoL. There was no association in adjusted analyses between PHM use and 3-year mortality (47.8%-63.8%).
PHM use is highly prevalent in institutional settings, regardless of the definition of inappropriateness. Residents who used multiple categories of PHMs were at greatest risk of poor HRQoL, poor PWB, and poor self-rated health. However, there was no apparent association with increased mortality. Given the importance of quality of life as an outcome to older people, further efforts are needed to minimize PHM use in this setting.
本研究调查了 3 种不同潜在有害药物（PHM）使用定义之间的重叠情况，以及它们与居民生活质量和死亡率的相应关联。
具有 3 年死亡率随访的横断面研究。
芬兰赫尔辛基和库奥皮奥的辅助生活设施和养老院。
共有 326 名居民。
PHM 使用的定义为：（1）使用具有抗胆碱能特性的药物，（2）使用 Beers 标准药物，（3）同时使用 3 种或更多精神药物。使用 15D 和心理幸福感（PWB）量表评估与健康相关的生活质量（HRQoL）。居民使用 4 分制自我评估自己的健康状况。死亡率数据从中央登记处获得。
根据定义 1（G1）、定义 2（G2）和定义 3（G3），分别有 38.0%、28.2%和 12.6%的居民使用 PHM。总体而言，根据这 3 种定义中的任何一种，有 21.2%的居民未使用 PHM（G0）。各组之间的合并症、认知或功能无显著差异。在调整分析中，使用多种 PHM 与较差的自我报告健康状况、较差的 PWB 和较差的 HRQoL 呈逐步关联。在调整分析中，PHM 使用与 3 年死亡率（47.8%-63.8%）之间无关联。
在机构环境中，PHM 使用非常普遍，无论不适当的定义如何。使用多种 PHM 类别的居民面临最大的 HRQoL、PWB 和自我报告健康状况较差的风险。然而，与死亡率增加没有明显关联。鉴于生活质量对老年人的重要性，需要进一步努力在这种环境中尽量减少 PHM 的使用。
