Yusupov Eleanor, Chen Davina, Krishnamachari Bhuma
Department of Clinical Specialties, New York Institute of Technology College of Osteopathic Medicine (NYIT COM), Old Westbury, NY, USA.
New York Institute of Technology College of Osteopathic Medicine (NYIT COM), Old Westbury, NY, USA.
SAGE Open Med. 2017 Nov 20;5:2050312117743673. doi: 10.1177/2050312117743673. eCollection 2017.
Our goal was to assess the association between potentially inappropriate medication use and risk of falls in the Parkinson's disease population.
This was a retrospective cohort study conducted at an outpatient Parkinson's Disease Treatment Center. Individuals 65 years of age or older, diagnosed with Parkinson's disease who attended at least three visits in 2015 for physical, occupational therapy, or physician's visits were included in the study. Electronic medical records were utilized to perform chart reviews, and medications were analyzed to identify prescription medications, combination preparations, over-the-counter medications, and dietary supplements. The goal of this study was to test the following hypothesis: elderly individuals with Parkinson's disease who take multiple potentially inappropriate medications are more likely to experience a fall compared to elderly individuals with Parkinson's disease who do not take multiple potentially inappropriate medications.
A higher mean number of prescription medications were associated with falls in elderly Parkinson's disease patients (6.53 vs 5.21, p < 0.01). Polypharmacy (taking five or more prescription and nonprescription medications) was not significantly associated with falls. Patients taking potentially inappropriate medications specifically contraindicated for those with a history of falls and fractures were more likely to report falls (p < 0.04). Analysis of the specific therapeutic medication categories demonstrated no significant differences between those who did and did not report falls.
A future prospective study at Parkinson's disease center should include an electronic medical record-based intervention to reduce the total number of medications, as well as to minimize the use of high-risk medications.
我们的目标是评估帕金森病患者中潜在不适当用药与跌倒风险之间的关联。
这是一项在门诊帕金森病治疗中心进行的回顾性队列研究。纳入年龄在65岁及以上、被诊断为帕金森病且在2015年至少就诊三次以接受物理治疗、职业治疗或看医生的患者。利用电子病历进行病历审查，并对药物进行分析，以确定处方药、复方制剂、非处方药和膳食补充剂。本研究的目的是检验以下假设：与未服用多种潜在不适当药物的帕金森病老年患者相比，服用多种潜在不适当药物的帕金森病老年患者更有可能跌倒。
老年帕金森病患者中，较高的平均处方药数量与跌倒相关（6.53对5.21，p<0.01）。多重用药（服用五种或更多处方药和非处方药）与跌倒无显著关联。服用有跌倒和骨折史者明确禁忌的潜在不适当药物的患者更有可能报告跌倒（p<0.04）。对特定治疗药物类别的分析表明，报告跌倒和未报告跌倒的患者之间无显著差异。
帕金森病中心未来的前瞻性研究应包括基于电子病历的干预措施，以减少药物总数，并尽量减少高风险药物的使用。
