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[老年人药物治疗:明智选择]

[Drug therapy for older people : Choosing wisely].

作者信息

Wehling Martin

机构信息

Klinische Pharmakologie Mannheim KPM, Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.

出版信息

Z Gerontol Geriatr. 2017 Dec;50(8):685-688. doi: 10.1007/s00391-017-1312-5. Epub 2017 Sep 22.

DOI:10.1007/s00391-017-1312-5
PMID:28939983
Abstract

Elderly people are the most rapidly growing sector of our society. Due to their multimorbidity they are exposed to a multitude of medications, which are accompanied by chances and risks. The problem of inappropriate medication in the elderly is exacerbated by the fact that only a holistic view can help these patients and that this is predominantly the responsibility of the general practitioner. The closely measured paid contact time is often insufficient to optimize complex medications. Clinically successfully tested aids in the form of lists give reason for hope: in particular, the positive/negative assessment of limitations of the elderly with respect to drugs by the STOPP/START criteria and the FORTA classification are clinically successful aids. Purely negative lists, such as the Beers or PRISCUS lists, have been disappointing in clinical application because they do not consider the needs, prognostic and particularly symptomatic importance and weighting of the diagnosis of patients. Further implementation of these aids to decision making should help to improve the problem of care of elderly patients in the field of drug treatment, even in IT systems.

摘要

老年人是我们社会中增长最为迅速的群体。由于他们患有多种疾病,会接触到大量药物,这些药物既有机会也有风险。老年人用药不当的问题因以下事实而加剧:只有全面的观点才能帮助这些患者,而这主要是全科医生的责任。经过严格计量的付费诊疗时间往往不足以优化复杂的药物治疗。以清单形式出现的经临床成功测试的辅助工具带来了希望:特别是,根据STOPP/START标准和FORTA分类法对老年人用药限制进行的阳性/阴性评估是临床上成功的辅助工具。纯粹的负面清单,如Beers清单或PRISCUS清单,在临床应用中令人失望,因为它们没有考虑患者的需求、预后,尤其是诊断的症状重要性和权重。这些决策辅助工具的进一步实施应有助于改善老年患者在药物治疗领域的护理问题,即使在信息技术系统中也是如此。

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本文引用的文献

1
Older People, a Plethora of Drugs, and Drug List Approaches: Useful, Efficacious, or a Waste of Time?老年人、大量药物与药物清单方法:有用、有效还是浪费时间?
J Am Med Dir Assoc. 2016 Dec 1;17(12):1073-1075. doi: 10.1016/j.jamda.2016.08.023. Epub 2016 Oct 15.
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Prevention of Hospital-Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial.使用老年人处方筛查工具和正确治疗标准警示筛查工具预防老年人医院获得性药物不良反应:一项整群随机对照试验
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2015年FORTA(适合老年人)清单:一种经过验证的用于改善老年人药物治疗的临床工具的更新。
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Dtsch Med Wochenschr. 2015 Sep;140(18):1378-82. doi: 10.1055/s-0041-103205. Epub 2015 Sep 11.
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Guideline-driven polypharmacy in elderly, multimorbid patients is basically flawed: there are almost no guidelines for these patients.针对老年多病患者的指南驱动的多药治疗基本上存在缺陷:几乎没有针对这些患者的指南。
J Am Geriatr Soc. 2011 Feb;59(2):376-7. doi: 10.1111/j.1532-5415.2011.03252.x.
8
Potentially inappropriate medications in the elderly: the PRISCUS list.老年人潜在不适当用药:PRISCUS 清单。
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9
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