针对患有多种慢性病的老年人的指南推荐药物与身体功能
Guideline-Recommended Medications and Physical Function in Older Adults with Multiple Chronic Conditions.
作者信息
McAvay Gail, Allore Heather G, Cohen Andrew B, Gnjidic Danijela, Murphy Terrence E, Tinetti Mary E
机构信息
Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut.
出版信息
J Am Geriatr Soc. 2017 Dec;65(12):2619-2626. doi: 10.1111/jgs.15065. Epub 2017 Sep 14.
BACKGROUND/OBJECTIVES: The benefit or harm of a single medication recommended for one specific condition can be difficult to determine in individuals with multiple chronic conditions and polypharmacy. There is limited information on the associations between guideline-recommended medications and physical function in older adults with multiple chronic conditions. The objective of this study was to estimate the beneficial or harmful associations between guideline-recommended medications and decline in physical function in older adults with multiple chronic conditions.
DESIGN
Prospective observational cohort.
SETTING
National.
PARTICIPANTS
Community-dwelling adults aged 65 and older from the Medicare Current Beneficiary Survey study (N = 3,273). Participants with atrial fibrillation, coronary artery disease, depression, diabetes mellitus, or heart failure were included.
MEASUREMENTS
Self-reported decline in physical function; guideline-recommended medications; polypharmacy (taking <7 vs ≥7 concomitant medications); chronic conditions; and sociodemographic, behavioral, and health risk factors.
RESULTS
The risk of decline in function in the overall sample was highest in participants with heart failure (35.4%, 95% confidence interval (CI) = 26.3-44.5) and lowest for those with atrial fibrillation (20.6%, 95% CI = 14.9-26.2). In the overall sample, none of the six guideline-recommended medications was associated with decline in physical function across the five study conditions, although in the group with low polypharmacy exposure, there was lower risk of decline in those with heart failure taking renin angiotensin system blockers (hazard ratio (HR) = 0.40, 95% CI = 0.16-0.99) and greater risk of decline in physical function for participants with diabetes mellitus taking statins (HR = 2.27, 95% CI = 1.39-3.69).
CONCLUSIONS
In older adults with multiple chronic conditions, guideline-recommended medications for atrial fibrillation, coronary artery disease, depression, diabetes mellitus, and heart failure were largely not associated with self-reported decline in physical function, although there were associations for some medications in those with less polypharmacy.
背景/目的：对于患有多种慢性病且使用多种药物的个体而言，很难确定针对某一特定病症推荐使用的单一药物的益处或危害。关于指南推荐药物与患有多种慢性病的老年人身体功能之间的关联，相关信息有限。本研究的目的是评估指南推荐药物与患有多种慢性病的老年人身体功能下降之间的有益或有害关联。
设计
前瞻性观察队列研究。
地点
全国范围。
参与者
来自医疗保险当前受益人调查研究的65岁及以上社区居住成年人（N = 3273）。纳入患有心房颤动、冠状动脉疾病、抑郁症、糖尿病或心力衰竭的参与者。
测量指标
自我报告的身体功能下降情况；指南推荐药物；多重用药情况（服用<7种与≥7种合并用药）；慢性病；以及社会人口学、行为和健康风险因素。
结果
在整个样本中，心力衰竭患者功能下降的风险最高（35.4%，95%置信区间（CI）= 26.3 - 44.5），心房颤动患者最低（20.6%，95% CI = 14.9 - 26.2）。在整个样本中，六种指南推荐药物中没有一种与五项研究病症中的身体功能下降相关，尽管在多重用药暴露较低的组中，服用肾素血管紧张素系统阻滞剂的心力衰竭患者功能下降风险较低（风险比（HR）= 0.40，95% CI = 0.16 - 0.99），而服用他汀类药物的糖尿病患者身体功能下降风险较高（HR = 2.27，95% CI = 1.39 - 3.69）。
结论
在患有多种慢性病的老年人中，指南推荐用于心房颤动、冠状动脉疾病、抑郁症、糖尿病和心力衰竭的药物在很大程度上与自我报告的身体功能下降无关，尽管在多重用药较少的人群中某些药物存在关联。
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