Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul, Turkey.
Department of Internal Medicine, Division of Geriatrics, Marmara University Hospital, Istanbul, Turkey.
Geriatr Gerontol Int. 2017 Sep;17(9):1245-1251. doi: 10.1111/ggi.12850. Epub 2016 Aug 10.
To date, there is no study comparing the Beers 2012 and Screening Tool of Older Person's Prescriptions (STOPP) version 2 criteria, nor reporting a comparison of the prevalence of potentially inappropriate Prescribing (PIM) with STOPP version 2. We aimed to evaluate the prescriptions of patients admitted to a geriatric outpatient clinic with these tools, and to document the factors related to PIM use.
Older patients (aged ≥65 years) admitted to the outpatient clinic of a university hospital were retrospectively evaluated for PIM with Beers 2012 and STOPP version 2 criteria. Age; sex; chronic disease and number of drugs; and functional, depression and nutritional statuses were studied with regression analysis as possible factors related to PIM.
The study included 667 participants (63.1% women, mean age 77.6 ± 6.3 years). The mean number of drugs was 6.1 ± 3.4. PIM prevalence detected by STOPP version 2 was higher than that of the Beers 2012 criteria (39.1% vs 33.3%, respectively; P < 0.001; Z = -3.5) with moderate agreement in between (kappa = 0.44). Antipsychotics, over-the-counter vitamin/supplements, aspirin, selective-serotonin-reuptake-inhibitors and anticholinergics were the leading drug classes for PIM. The extent of polypharmacy (P < 0.001, OR 1.29, 95% CI 1.20-1.38) was the most important variable related to PIM, along with the multiple comorbidities (P = 0.005, OR 1.16, 95% CI 1.05-1.30). Higher level of functionality was inversely associated with PIM (P = 0.009, OR 0.90, 95% CI 0.83-0.97).
Inappropriate prescription prevalence of ~40% by STOPP version 2 was similar to the global worldwide prevalence - yet at the upper end. STOPP version 2 was more successful than Beers 2012 to detect PIM. Patients with multiple drug use, multiple comorbidities and more dependency were more likely to have PIM requiring special attention during prescription. Geriatr Gerontol Int 2017; 17: 1245-1251.
目前尚无研究比较 Beers 2012 标准和老年人用药适宜性筛查工具（STOPP）第 2 版标准，也没有报告使用 STOPP 第 2 版标准时潜在不适当处方（PIM）的流行率。本研究旨在使用这些工具评估老年门诊患者的处方，并记录与 PIM 使用相关的因素。
对某大学医院老年门诊患者，采用 Beers 2012 标准和 STOPP 第 2 版标准评估 PIM。采用回归分析评估年龄、性别、慢性疾病和用药数量，以及功能、抑郁和营养状况等因素与 PIM 的关系。
本研究共纳入 667 例患者（63.1%为女性，平均年龄 77.6±6.3 岁），平均用药 6.1±3.4 种。STOPP 第 2 版标准检测到的 PIM 发生率高于 Beers 2012 标准（分别为 39.1%和 33.3%，P＜0.001；Z=-3.5），两者之间具有中等一致性（kappa=0.44）。PIM 发生率最高的药物类别是抗精神病药、非处方维生素/补充剂、阿司匹林、选择性 5-羟色胺再摄取抑制剂和抗胆碱能药物。多重用药（P＜0.001，OR 1.29，95%CI 1.20-1.38）和多种合并症（P=0.005，OR 1.16，95%CI 1.05-1.30）是与 PIM 相关的最重要变量。功能水平较高与 PIM 呈负相关（P=0.009，OR 0.90，95%CI 0.83-0.97）。
STOPP 第 2 版标准检测到的 PIM 发生率约为 40%，与全球 PIM 发生率相近，但处于较高水平。STOPP 第 2 版标准比 Beers 2012 标准更能成功地检测出 PIM。多重用药、多种合并症和更高依赖性的患者更有可能需要特别注意处方中的 PIM。
