J Am Dent Assoc. 2017 May;148(5):298-307. doi: 10.1016/j.adaj.2017.01.020. Epub 2017 Mar 8.
An aging population indicates that increasing numbers of older adults will seek oral health care and have multiple chronic conditions treated with a number of medications. The authors examined the Medicare Current Beneficiary Survey administrative data set to characterize potentially inappropriate medication (PIM) use by older adults visiting the dentist and related adverse experiences that may affect oral health care.
The authors used the 2015 Beers criteria to identify PIMs for older adults. The authors examined the Medicare Current Beneficiary Survey administrative data set for community-dwelling older adults with dental care visits and reported national prevalence estimates of Beers criteria medication prescribing. The authors used logistic regression to identify sociodemographic and health-related characteristics associated with potentially inappropriate prescribing. The authors described medication-related adverse experiences affecting dental care.
Among older adults with dental care visits, 56.9% received a prescription for at least 1 Beers criteria medication, and 28.3% received a prescription for 2 or more Beers criteria medications. Beers criteria medication use was associated most strongly with the number of comorbid diseases as represented by higher Charlson Index scores (odds ratios, > 1.0).
A substantial proportion of community-dwelling older adults visiting dentists had received prescriptions for 1 or more potentially age-inappropriate Beers criteria medications. Many of these medications have adverse effects that could affect patient safety and oral health care.
These results support the need for clinicians to be aware of PIM use by older adults, recognize associated medication-related adverse events, and avoid prescribing age-inappropriate medications to this vulnerable patient population.
人口老龄化意味着越来越多的老年人将寻求口腔保健,并使用多种药物治疗多种慢性疾病。作者检查了医疗保险当前受益人调查的管理数据集,以描述看牙医的老年人中潜在不适当药物(PIM)的使用情况,以及可能影响口腔保健的相关不良体验。
作者使用 2015 年 Beers 标准来确定老年人的 PIM。作者检查了医疗保险当前受益人调查的管理数据集,以了解接受牙科护理的社区居住老年人,并报告了全国范围内 Beers 标准药物处方的患病率估计值。作者使用逻辑回归来确定与潜在不适当处方相关的社会人口统计学和健康相关特征。作者描述了影响口腔保健的与药物相关的不良体验。
在接受牙科护理的老年人中,有 56.9%的人至少开了一种 Beers 标准药物,28.3%的人开了两种或更多种 Beers 标准药物。Beers 标准药物的使用与代表合并症数量的更高 Charlson 指数评分(优势比,>1.0)最密切相关。
相当一部分到牙医处就诊的社区居住老年人收到了 1 种或多种潜在年龄不适当的 Beers 标准药物的处方。这些药物中有许多具有可能影响患者安全和口腔保健的不良作用。
这些结果支持临床医生需要意识到老年人中 PIM 的使用,认识到相关的药物相关不良事件,并避免为这个脆弱的患者群体开不适当的药物。