Herr Marie, Sirven Nicolas, Grondin Hélène, Pichetti Sylvain, Sermet Catherine
UMR 1168, Vieillissement et Maladies Chroniques : Approches Epidémiologique et de Santé Publique, INSERM and Université Versailles St-Quentin-en-Yvelines, Villejuif & Montigny-le-Bretonneux, France.
Département Hospitalier d'Epidémiologie et de Santé Publique, Hôpital Sainte-Périne, Assistance Publique-Hôpitaux de Paris, Paris, France.
Eur J Clin Pharmacol. 2017 Sep;73(9):1165-1172. doi: 10.1007/s00228-017-2276-5. Epub 2017 Jun 11.
This study analyses the relationship between medication use and frailty by considering the quantity of medications prescribed (polypharmacy) and the quality of medication prescribing (according to French criteria for Potentially Inappropriate Medications-PIMs) in people aged 65 and over.
This is a cross-sectional study based on the data from a nationally representative study about health and use of healthcare resources in France (ESPS 2012). The number of frailty criteria was assessed among exhaustion, unintentional weight loss, muscle weakness, impaired mobility, and low level of physical activity. Polypharmacy and PIMs were assessed from the data of reimbursement by the National Health Insurance over the whole year 2012. PIMs were defined according to the Laroche list plus additional criteria dealing with inappropriate prolonged use of medications. The analyses used Poisson regression models, with the number of frailty criteria as dependent variable.
The study population was composed of 1003 women and 887 men, of mean age 74.7 +/- 7.4 years. Polypharmacy (5 to 9 drugs) and excessive polypharmacy (≥10 drugs) were reported in 42.9 and 27.4% of the study population, respectively, while 46.7% of the study population received at least one PIM during the year 2012. Polypharmacy and PIMs were both associated with the number of frailty criteria in models adjusted for socio-demographic and health characteristics of the participants. The prescription of anticholinergic medications was the only PIM that remained significantly associated with the number of frailty criteria after adjustment for polypharmacy.
Polypharmacy and use of anticholinergic medications are independently associated with frailty in old people.
本研究通过考虑65岁及以上人群的用药量（多重用药）和用药处方质量（根据法国潜在不适当用药标准-PIMs）来分析药物使用与衰弱之间的关系。
这是一项横断面研究，基于法国一项关于健康和医疗资源使用的全国代表性研究（ESPS 2012）的数据。在疲劳、非故意体重减轻、肌肉无力、行动能力受损和身体活动水平低等方面评估衰弱标准的数量。多重用药和PIMs根据2012年全年国家健康保险的报销数据进行评估。PIMs根据拉罗什清单以及处理药物不适当长期使用的附加标准来定义。分析使用泊松回归模型，以衰弱标准的数量作为因变量。
研究人群包括1003名女性和887名男性，平均年龄为74.7±7.4岁。分别有42.9%和27.4%的研究人群报告存在多重用药（5至9种药物）和过度多重用药（≥10种药物），而46.7%的研究人群在2012年期间至少接受了一种PIM。在针对参与者的社会人口统计学和健康特征进行调整的模型中，多重用药和PIMs均与衰弱标准的数量相关。在对多重用药进行调整后，抗胆碱能药物的处方是唯一仍与衰弱标准数量显著相关的PIM。
多重用药和抗胆碱能药物的使用与老年人的衰弱独立相关。
