Ilango Sivarajah, Pillans Peter, Peel Nancye M, Scott Ian, Gray Leonard C, Hubbard Ruth E
Department of Clinical Pharmacology, The Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Department of Internal Medicine, The Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Intern Med J. 2017 Sep;47(9):1019-1025. doi: 10.1111/imj.13526.
While medications may prolong life and prevent morbidity in older people, adverse effects of polypharmacy are increasingly recognised. As patients age and become frail, prescribing may be expected to focus more on symptom control and minimise potentially harmful preventive medication use that confer little benefit within a short lifespan. Whether prescribing practice shifts to one of symptom controls among the oldest old admitted to hospital remains unclear.
To determine, in the oldest old inpatients, whether preventive versus symptom control medication prescribing was associated with age or level of frailty.
Retrospective analysis of all patients aged ≥85 years referred for comprehensive geriatric assessment at a tertiary care hospital between May 2006 and December 2014 for whom all prescribed medications were documented. Medication use was assessed according to age group (85-89, 90-94, ≥95) and categories of frailty index calculated for patients based on 52 deficits (fitter, moderately frail, frail and severely frail).
Seven hundred and eighty-three inpatients were assessed of mean (SD) age 89.0 (3.4) and mean frailty index 0.45 (SD 0.14) with a median of eight co-morbidities (IQR 6-10) and who were prescribed a mean of 8.3 (SD 3.8) regular medications per day. Polypharmacy (5-9 medications per day) was observed in 406 patients (51.9%) and hyper-polypharmacy (≥10 medications per day) in 268 patients (34.2%). While there was a significant decrease in number of prescribed medications as age increased, there were no differences across age groups or frailty categories in proportions of medications used for prevention versus symptom control.
Polypharmacy is prevalent in oldest old inpatients and prescribing patterns according to prevention versus symptom control appear unaffected by age and frailty status.
虽然药物可以延长老年人的寿命并预防疾病，但多重用药的不良反应越来越受到关注。随着患者年龄增长且身体变得虚弱，处方可能更应侧重于症状控制，并尽量减少在短寿命内益处不大的潜在有害预防性药物的使用。对于入住医院的高龄老人，处方实践是否转向症状控制之一仍不清楚。
确定在高龄住院患者中，预防性用药与症状控制用药的处方是否与年龄或虚弱程度相关。
对2006年5月至2014年12月在一家三级护理医院接受综合老年评估的所有年龄≥85岁的患者进行回顾性分析，这些患者的所有处方药物均有记录。根据年龄组（85 - 89岁、90 - 94岁、≥95岁）以及基于52项缺陷为患者计算的虚弱指数类别（身体状况较好、中度虚弱、虚弱和重度虚弱）评估药物使用情况。
评估了783名住院患者，平均（标准差）年龄为89.0（3.4）岁，平均虚弱指数为0.45（标准差0.14），中位数为8种合并症（四分位间距6 - 10），每天平均开具8.3（标准差3.8）种常规药物。406名患者（51.9%）存在多重用药（每天5 - 9种药物），268名患者（34.2%）存在超多重用药（每天≥10种药物）。虽然随着年龄增加，处方药物数量显著减少，但在预防用药与症状控制用药比例方面，各年龄组或虚弱类别之间没有差异。
多重用药在高龄住院患者中普遍存在，根据预防与症状控制的处方模式似乎不受年龄和虚弱状态影响。
