Giovannini Silvia, van der Roest Henriëtte G, Carfì Angelo, Finne-Soveri Harriet, Garms-Homolová Vjenka, Declercq Anja, Jónsson Pálmi V, van Hout Hein, Vetrano Davide L, Gravina Ester Manes, Bernabei Roberto, Onder Graziano
Department of Gerontology and Geriatrics, A. Gemelli Foundation, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Roma, Italy.
Drugs Aging. 2018 Feb;35(2):145-152. doi: 10.1007/s40266-018-0521-y.
Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe.
We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Data were collected using the interResident Assessment Instrument (interRAI) instrument for HC. Polypharmacy status was categorized into three groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs), and excessive polypharmacy (≥ 10 drugs). Multinomial logistic regressions were used to identify variables associated with polypharmacy and excessive polypharmacy.
Polypharmacy was observed in 730 (39.0%) HC patients and excessive polypharmacy in 433 (23.1%). As compared with non-polypharmacy, excessive polypharmacy was directly associated with chronic disease but also with female sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.17-2.13), pain (OR 1.51; 95% CI 1.15-1.98), dyspnea (OR 1.37; 95% CI 1.01-1.89), and falls (OR 1.55; 95% CI 1.01-2.40). An inverse association with excessive polypharmacy was shown for age (OR 0.69; 95% CI 0.56-0.83).
Polypharmacy and excessive polypharmacy are common among HC patients in Europe. Factors associated with polypharmacy status include not only co-morbidity but also specific symptoms and age.
居家护理（HC）患者的特点是病情高度复杂，这体现在多种疾病的普遍存在以及相关的高药物消费量上。本研究评估了欧洲HC患者样本中多重用药的患病率及相关因素。
我们对来自六个欧洲国家的1873名HC患者进行了横断面分析，这些患者参与了通过社区护理成本和结果基准确定依赖护理老年人的最佳实践（IBenC）项目。使用针对HC的居民间评估工具（interRAI）收集数据。多重用药状态分为三组：非多重用药（0 - 4种药物）、多重用药（5 - 9种药物）和过度多重用药（≥10种药物）。采用多项逻辑回归来确定与多重用药和过度多重用药相关的变量。
730名（39.0%）HC患者存在多重用药情况，433名（23.1%）存在过度多重用药情况。与非多重用药相比，过度多重用药不仅与慢性病直接相关，还与女性性别（比值比[OR] 1.58；95%置信区间[CI] 1.17 - 2.13）、疼痛（OR 1.51；95% CI 1.15 - 1.98）、呼吸困难（OR 1.37；95% CI 1.01 - 1.89）和跌倒（OR 1.55；95% CI 1.01 - 2.40）相关。年龄与过度多重用药呈负相关（OR 0.69；95% CI 0.56 - 0.83）。
多重用药和过度多重用药在欧洲HC患者中很常见。与多重用药状态相关的因素不仅包括合并症，还包括特定症状和年龄。
