Ie Kenya, Chou Eric, Boyce Richard D, Albert Steven M
Department of Family Medicine, University of Pittsburgh, 3518 Fifth Avenue, Pittsburgh, PA, 15213, USA.
Kawasaki Municipal Tama Hospital/St. Marianna University School of Medicine, 1-30-37 Shukugawara, Kawasaki, Kanagawa, 214-8525, Japan.
Drugs Real World Outcomes. 2017 Dec;4(4):257-264. doi: 10.1007/s40801-017-0123-8.
Several scales to quantify the impact of potentially harmful medications (PHMs) have been shown to predict mortality and functional decline; however, the effect of PHMs on quality of life (QoL) has not been well-studied.
The aims of this study were to investigate an association between PHM use and change in health-related QoL among community-dwelling older adults, and to compare the predictive capacity of PHM scales.
We conducted a retrospective cohort study using prescription claims data and survey responses. A total of 426 community-dwelling adults aged 65 years or older who visited senior centers and had received prescriptions through a statewide prescription drug subsidy program were included. Anticholinergic Cognitive Burden (ACB), Drug Burden Index-sedative component (DBI-Se), Drug Burden Index-anticholinergic component (DBI-ACh), and the number of regular medications and Beers list medications were calculated from the claims data between baseline and 12 months. In addition, change in the EuroQoL five-dimensions questionnaire (EQ-5D) between baseline and 6- and 12-month follow-up were measured as the main outcome. A linear mixed model was used for the analysis.
After adjusting for covariates, both DBI-Se (coefficients - 0.076, 95% confidence interval [CI] - 0.131 to - 0.020) and DBI-Ach (coefficients - 0.095, 95% CI - 0.188 to - 0.002) significantly predicted a decline in EQ-5D index. The ACB, number of regular medications, and number of Beers medications did not have a significant association with EQ-5D changes.
PHM measures incorporating dose revealed a better predictive capacity for QoL change. Reducing cumulative drug dose, as well as stopping medications, would be important for the well-being of this population.
已证实几种用于量化潜在有害药物（PHM）影响的量表可预测死亡率和功能衰退；然而，PHM对生活质量（QoL）的影响尚未得到充分研究。
本研究旨在调查社区居住的老年人中PHM使用与健康相关生活质量变化之间的关联，并比较PHM量表的预测能力。
我们使用处方索赔数据和调查回复进行了一项回顾性队列研究。纳入了426名年龄在65岁及以上、访问过老年中心并通过全州处方药补贴计划接受过处方的社区居住成年人。根据基线和12个月之间的索赔数据计算抗胆碱能认知负担（ACB）、药物负担指数－镇静成分（DBI－Se）、药物负担指数－抗胆碱能成分（DBI－ACh）以及常规药物和Beers清单药物的数量。此外，将基线与6个月和12个月随访之间欧洲五维健康量表（EQ－5D）的变化作为主要结局进行测量。采用线性混合模型进行分析。
在对协变量进行调整后，DBI－Se（系数－0.076，95％置信区间[CI]－0.131至－0.020）和DBI－Ach（系数－0.095，95％CI－0.188至－0.002）均显著预测了EQ－5D指数的下降。ACB、常规药物数量和Beers药物数量与EQ－5D变化无显著关联。
纳入剂量的PHM测量方法对生活质量变化具有更好的预测能力。减少累积药物剂量以及停药对该人群的健康很重要。
