Notenboom Kim, Vromans Herman, Schipper Maarten, Leufkens Hubert G M, Bouvy Marcel L
Department of Public Health Effects, National Institute for Public Health and the EnvironmentBilthoven, Netherlands; CBG, Medicines Evaluation BoardUtrecht, Netherlands.
Department of Pharmaceutical Sciences, Faculty of Science, Utrecht UniversityUtrecht, Netherlands; Department of Clinical and Compounding Pharmacy, University Medical Centre UtrechtUtrecht, Netherlands.
Front Pharmacol. 2016 Jul 26;7:222. doi: 10.3389/fphar.2016.00222. eCollection 2016.
Practical problems with the use of medicines, such as difficulties with breaking tablets, are an often overlooked cause for non-adherence. Tablets frequently break in uneven parts and loss of product can occur due to crumbling and powdering. Health characteristics, such as the presence of peripheral neuropathy, decreased grip strength and manual dexterity, can affect a patient's ability to break tablets. As these impairments are associated with aging and age-related diseases, such as Parkinson's disease and arthritis, difficulties with breaking tablets could be more prevalent among older adults. The objective of this study was to investigate the relationship between age and the ability to break scored tablets.
A comparative study design was chosen. Thirty-six older adults and 36 young adults were systematically observed with breaking scored tablets. Twelve different tablets were included. All participants were asked to break each tablet by three techniques: in between the fingers with the use of nails, in between the fingers without the use of nails and pushing the tablet downward with one finger on a solid surface. It was established whether a tablet was broken or not, and if broken, whether the tablet was broken accurately or not.
The older adults experienced more difficulties to break tablets compared to the young adults. On average, the older persons broke 38.1% of the tablets, of which 71.0% was broken accurately. The young adults broke 78.2% of the tablets, of which 77.4% was broken accurately. Further analysis by mixed effects logistic regression revealed that age was associated with the ability to break tablets, but not with the accuracy of breaking.
Breaking scored tablets by hand is less successful in an elderly population compared to a group of young adults. Health care providers should be aware that tablet breaking is not appropriate for all patients and for all drugs. In case tablet breaking is unavoidable, a patient's ability to break tablets should be assessed by health care providers and instructions on the appropriate method of breaking should be provided.
药物使用中的实际问题，如掰碎药片困难，是导致不依从的一个常被忽视的原因。药片经常会碎成不均匀的部分，并且由于破碎和粉末化会导致药品损失。健康特征，如周围神经病变、握力下降和手部灵活性降低，会影响患者掰碎药片的能力。由于这些损伤与衰老及年龄相关疾病（如帕金森病和关节炎）有关，掰碎药片困难在老年人中可能更为普遍。本研究的目的是调查年龄与掰碎刻痕药片能力之间的关系。
选择了一项比较研究设计。对36名老年人和36名年轻人掰碎刻痕药片的过程进行了系统观察。纳入了12种不同的药片。要求所有参与者通过三种技术掰碎每片药片：用指甲在手指间掰、不用指甲在手指间掰以及用一根手指在坚实表面向下按压药片。确定药片是否被掰碎，如果掰碎了，确定药片是否被准确掰碎。
与年轻人相比，老年人掰碎药片遇到更多困难。平均而言，老年人掰碎了38.1%的药片，其中71.0%被准确掰碎。年轻人掰碎了78.2%的药片，其中77.4%被准确掰碎。通过混合效应逻辑回归进一步分析发现，年龄与掰碎药片的能力有关，但与掰碎的准确性无关。
与年轻人群体相比，老年人群体手动掰碎刻痕药片的成功率较低。医疗保健提供者应意识到，并非所有患者和所有药物都适合掰碎药片。如果不可避免要掰碎药片，医疗保健提供者应评估患者掰碎药片的能力，并提供关于合适掰碎方法的指导。
