Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel.
J Am Geriatr Soc. 2016 Jul;64(7):1432-8. doi: 10.1111/jgs.14213. Epub 2016 Jun 15.
To investigate the association between polypharmacy and mortality in nursing home (NH) residents.
Prospective observational cohort study.
Six NHs in central Israel.
Mobile with dementia and fully dependent residents (N = 764; n = 558 (73%) fully dependent, n = 206 (27%) mobile residents with dementia requiring institutional care; mean age 82.2 ± 5.9).
Two-year mortality and its association with number of drugs that individual residents were taking at baseline, controlled for multiple confounders.
At baseline, 268 residents were taking five or fewer drugs per day, 202 were taking six or seven, and 294 were taking eight or more. In the multivariate analysis, the likelihood of dying within 2 years in the group taking six or seven drugs per day (odds ratio (OR = 0.95, 95% CI = 0.63-1.43) and in those taking eight or more (OR = 1.20, 95% CI = 0.78-1.84) was similar to that of those taking five or fewer. Variables at baseline independently associated with greater mortality were male sex (OR = 1.75, 95% CI = 1.24-2.46), older age (OR = 1.07, 95% CI = 1.04-1.10), higher Charlson Comorbidity Index (OR = 1.17, 95% CI = 1.04-1.30), and taking anticoagulant (OR = 1.78, 95% CI = 1.01-3.13) or antihyperglycemic medication (OR = 1.69, 95% CI = 1.12-2.53). Variables at baseline independently associated with lower mortality were higher body mass index (OR = 0.99, 95% CI = 0.93-0.99) and taking lipid-lowering medication (OR = 0.54, 95% CI = 0.36-0.80) and selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors (OR = 0.52, 95% CI = 0.37-0.75).
Polypharmacy, defined quantitatively according to number of drugs, was not associated with mortality in these NH residents.
调查养老院（NH）居民中多种药物治疗与死亡率之间的关系。
前瞻性观察队列研究。
以色列中部的 6 家 NH。
有认知障碍且完全依赖他人的居民（N=764；n=558（73%）完全依赖，n=206（27%）有认知障碍的行动不便者，需要机构护理；平均年龄 82.2±5.9）。
两年死亡率及其与个体居民在基线时服用药物数量的关系，控制了多个混杂因素。
在基线时，268 名居民每天服用五种或更少药物，202 名服用六种或七种，294 名服用八种或更多药物。在多变量分析中，每天服用六种或七种药物组（比值比（OR）=0.95，95%置信区间（CI）=0.63-1.43）和每天服用八种或更多药物组（OR=1.20，95% CI=0.78-1.84）的死亡可能性与服用五种或更少药物的组相似。基线时与死亡率增加独立相关的变量为男性（OR=1.75，95% CI=1.24-2.46）、年龄较大（OR=1.07，95% CI=1.04-1.10）、较高的 Charlson 合并症指数（OR=1.17，95% CI=1.04-1.30）以及服用抗凝剂（OR=1.78，95% CI=1.01-3.13）或抗高血糖药物（OR=1.69，95% CI=1.12-2.53）。基线时与死亡率降低独立相关的变量为较高的体重指数（OR=0.99，95% CI=0.93-0.99）和服用降脂药物（OR=0.54，95% CI=0.36-0.80）以及选择性 5-羟色胺再摄取抑制剂或 5-羟色胺去甲肾上腺素再摄取抑制剂（OR=0.52，95% CI=0.37-0.75）。
根据服用药物的数量定量定义的多种药物治疗与这些 NH 居民的死亡率无关。
