Parsons Carole
Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK.
Ther Adv Drug Saf. 2017 Jan;8(1):31-46. doi: 10.1177/2042098616670798. Epub 2016 Oct 1.
Multimorbidity and polypharmacy are increasingly prevalent across healthcare systems and settings as global demographic trends shift towards increased proportions of older people in populations. Numerous studies have demonstrated an association between polypharmacy and potentially inappropriate prescribing (PIP), and have reported high prevalence of PIP across settings of care in Europe and North America and, as a consequence, increased risk of adverse drug reactions, healthcare utilization, morbidity and mortality. These studies have not focused specifically on people with dementia, despite the high risk of adverse drug reactions and PIP in this patient cohort. This narrative review considers the evidence currently available in the area, including studies examining prevalence of PIP in older people with dementia, how appropriateness of prescribing is assessed, the medications most commonly implicated, the clinical consequences, and research priorities to optimize prescribing for this vulnerable patient group. Although there has been a considerable research effort to develop criteria to assess medication appropriateness in older people in recent years, the majority of tools do not focus on people with dementia. Of the limited number of tools available, most focus on the advanced stages of dementia in which life expectancy is limited. The development of tools to assess medication appropriateness in people with mild to moderate dementia or across the full spectrum of disease severity represents an important gap in the research literature and is beginning to attract research interest, with recent studies considering the medication regimen as a whole, or misprescribing, overprescribing or underprescribing of certain medications/medication classes, including anticholinergics, psychotropics, antibiotics and analgesics. Further work is required in development and validation of criteria to assess prescribing appropriateness in this vulnerable patient population, to determine prevalence of PIP in large cohorts of people with the full spectrum of dementia variants and severities, and to examine the impact of PIP on health outcomes.
随着全球人口趋势向老年人口比例增加转变，多重疾病和多种药物治疗在医疗保健系统和环境中越来越普遍。众多研究表明，多种药物治疗与潜在不适当处方（PIP）之间存在关联，并报告了欧洲和北美的各种护理环境中PIP的高患病率，因此药物不良反应、医疗保健利用率、发病率和死亡率的风险增加。尽管该患者群体中药物不良反应和PIP的风险很高，但这些研究并未特别关注痴呆症患者。本叙述性综述考虑了该领域目前可用的证据，包括研究痴呆症老年患者中PIP的患病率、如何评估处方的适当性、最常涉及的药物、临床后果以及优化该脆弱患者群体处方的研究重点。尽管近年来为制定评估老年人用药适当性的标准付出了相当大的研究努力，但大多数工具并未关注痴呆症患者。在可用的有限数量的工具中，大多数关注预期寿命有限的痴呆症晚期阶段。开发评估轻度至中度痴呆症患者或疾病严重程度全范围内用药适当性的工具是研究文献中的一个重要空白，并且开始吸引研究兴趣，最近的研究考虑了整个药物治疗方案，或某些药物/药物类别（包括抗胆碱能药物、精神药物、抗生素和镇痛药）的处方错误、处方过量或处方不足。在开发和验证评估该脆弱患者群体处方适当性的标准、确定全范围痴呆症变体和严重程度的大型队列中PIP的患病率以及检查PIP对健康结果的影响方面，还需要进一步的工作。
