Axmon Anna, Sandberg Magnus, Ahlström Gerd, Midlöv Patrik
Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, SE, Sweden.
Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden.
BMC Pharmacol Toxicol. 2017 Oct 25;18(1):68. doi: 10.1186/s40360-017-0174-1.
Older people have a greater disease burden and are more likely than younger to be prescribed medications. They are also more sensitive to adverse effects. With this in mind, a range of medications have been suggested inappropriate in this population. People with intellectual disability (ID) have a higher disease burden than the general population, putting them at even greater risk of prescription of such medications. The aim of this study was to describe prescription of potentially inappropriate medications among older people with ID in relation to prescriptions among their age peers in the general population.
We established an administrative cohort of people with ID (ID cohort; n = 7936), using a Swedish national register. A referent cohort from the general population (gPop) was matched one-to-one by sex and year of birth. Data regarding prescription of potentially inappropriate medications were collected from the Swedish prescribed drug register for the years 2006-2012.
People with ID were more likely than the general population to be prescribed medications with anticholinergic effects, intermediate- or long-acting benzodiazepines, and antipsychotics at least once during the study period, and also had more number of years with prescription. Except for benzodiazepines, those in the ID cohort with at least one prescription had larger amounts prescribed than those in the gPop cohort. People in the ID cohort were less likely than the general population to be prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Among those with at least one prescription of NSAIDs, those in the ID cohort had prescriptions during fewer years and in lower amounts than those in the gPop cohort.
Although prescription of potentially inappropriate medications overall is more common among people with ID than in the general population, the opposite pattern is found for medications for pain management. This may be a result of pain being under-recognized and under-treated in this population. Thus, there is a need for training as well as increased knowledge and awareness among care and health care professionals regarding signs of adverse effects and the need of continuous evaluation of treatment in this vulnerable group.
老年人疾病负担较重，比年轻人更有可能被开具药物处方。他们对药物不良反应也更敏感。考虑到这一点，一系列药物被认为不适用于该人群。智力残疾（ID）患者的疾病负担高于一般人群，这使他们面临开具此类药物处方的风险更高。本研究的目的是描述ID老年患者中潜在不适当药物的处方情况，并与一般人群中同龄人进行比较。
我们利用瑞典国家登记册建立了一个ID患者管理队列（ID队列；n = 7936）。从一般人群（gPop）中选取一个对照队列，按性别和出生年份进行一对一匹配。2006 - 2012年期间，从瑞典处方药登记册收集潜在不适当药物的处方数据。
在研究期间，ID患者比一般人群更有可能至少一次被开具具有抗胆碱能作用的药物、中长效苯二氮䓬类药物和抗精神病药物，且开具处方的年份更多。除苯二氮䓬类药物外，ID队列中至少有一次处方的患者所开具药物的剂量比gPop队列中的患者更大。ID队列中的患者比一般人群更不可能被开具非甾体抗炎药（NSAIDs）。在至少有一次NSAIDs处方的患者中，ID队列中的患者开具处方的年份较少，剂量也低于gPop队列中的患者。
虽然ID患者中总体上开具潜在不适当药物的情况比一般人群更常见，但在疼痛管理药物方面却发现了相反的模式。这可能是由于该人群中疼痛未得到充分认识和治疗。因此，护理和医疗保健专业人员需要接受培训，提高对不良反应体征的认识以及对这一弱势群体进行持续治疗评估的意识。
