Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan.
Prince Sultan Military College of Health Sciences, King Fahd Military Medical Complex, Dhahran, Saudi Arabia.
Aging Clin Exp Res. 2018 Jan;30(1):53-60. doi: 10.1007/s40520-017-0742-7. Epub 2017 Mar 3.
Inappropriate prescribing in elderly patients is a widespread health problem. It is associated with increased drug-related problems and health expenditure.
To determine the prevalence and types of potentially inappropriate medications (PIM) prescribed to elderly patients with polypharmacy and the factors associated with their use in these patients.
A cross-sectional study conducted among 228 elderly hospitalized patients with polypharmacy. Elderly patients were defined as patients ≥65 years of age, and polypharmacy was defined as taking ≥5 drugs. Based on previously published criteria (Beers and STOPP), a list of 32 PIM was developed using a Delphi technique, which was used as a tool to detect the prevalence of PIM. Age, gender, comorbidity, patients' functional status, and complete medication history were recorded to evaluate as variables related to PIM. The association between PIM used and independent variables was also assessed.
The prevalence of PIM used among the hospitalized elderly patients was 64%. PIM use according to STOPP criteria was identified in 44% of patients, whereas Beers-listed PIM were identified in 50% of patients. The most frequently observed PIM were the combination of nonsteroidal anti-inflammatory drugs (NSAIDs) with antihypertensives and long-term NSAIDs, which account for more than 90 and 75% of the total observed PIM, respectively. Patients with age ≥85 years were more likely to be prescribed PIM. High comorbidity was found to be an independent predictor of PIM use. Polypharmacy with ≥10 drugs prescribed to patients predicted the presence of PIM.
The study showed a high prevalence of PIM use among hospitalized elderly patients. The consensus-validated list of PIM was a useful tool for screening inappropriate prescribing in this particular patient population.
Our findings support the need for measures to improve the quality of drug treatment in the elderly Pakistani population, especially among dependent patients with polypharmacy.
老年人用药不当是一个普遍存在的健康问题。它与药物相关问题和医疗支出的增加有关。
确定同时服用多种药物的老年患者中潜在不适当药物（PIM）的使用情况和类型，并确定这些患者使用 PIM 的相关因素。
这是一项横断面研究，共纳入 228 名同时服用多种药物的住院老年患者。将年龄≥65 岁的患者定义为老年患者，同时服用≥5 种药物的患者定义为同时服用多种药物的患者。根据先前发表的标准（Beers 和 STOPP），使用 Delphi 技术制定了一份包含 32 种 PIM 的清单，该清单被用作检测 PIM 患病率的工具。记录了年龄、性别、合并症、患者的功能状态和完整的药物史，以评估与 PIM 相关的变量。还评估了 PIM 使用与独立变量之间的关联。
住院老年患者中 PIM 的使用率为 64%。根据 STOPP 标准，44%的患者使用了 PIM，而根据 Beers 标准，50%的患者使用了 PIM。最常见的 PIM 是 NSAIDs 与降压药和长期 NSAIDs 的联合使用，分别占观察到的总 PIM 的 90%和 75%以上。年龄≥85 岁的患者更有可能被开处方使用 PIM。高合并症被发现是使用 PIM 的独立预测因素。给患者开≥10 种药物的同时服用多种药物预测了 PIM 的存在。
研究显示，住院老年患者中 PIM 的使用率很高。经过共识验证的 PIM 清单是筛选该特定患者群体中不适当处方的有用工具。
我们的研究结果支持采取措施提高巴基斯坦老年人群药物治疗质量的必要性，尤其是在依赖同时服用多种药物的患者中。
