King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), De Crespigny Park, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom.
King's College London, Department of Primary Care and Public Health Sciences, London, UK.
Exp Gerontol. 2018 Jun;106:240-245. doi: 10.1016/j.exger.2018.02.011. Epub 2018 Feb 13.
Polypharmacy has been linked to higher risks of hospitalisation and death in community samples. It is commonly present in people with dementia but these risks have rarely been studied in this population. We aimed to investigate associations between polypharmacy and emergency department attendance, any and unplanned hospitalisation, and mortality in patients with dementia. Using a large mental health care database in South London, linked to hospitalisation and mortality data, we assembled a retrospective cohort of patients diagnosed with dementia. We ascertained number of medications prescribed at the time of dementia diagnosis and conducted multivariate Cox regression analyses. Of 4668 patients with dementia identified, 1128 (24.2%) were prescribed 4-6 medications and 739 (15.8%) ≥7 medications. Compared to those using 0-3 medications, patients with dementia using 4-6 or ≥7 agents had an increased risk of emergency department attendance (hazard ratio 1.20/1.35), hospitalisation (hazard ratio 1.12/1.32), unplanned hospital admission (hazard ratio 1.12/1.25), and death within two years (hazard ratio 1.29/1.39) after controlling for potential confounders. We found evidence of a dose response relationship with each additional drug at baseline increasing the risk of emergency department attendance and mortality by 5% and hospitalisation by 3%. In conclusion, polypharmacy at dementia diagnosis is associated with a higher risk of adverse health outcomes. Future research is required to elucidate which specific agents underlie this relationship and if reduction of inappropriate prescribing is effective in preventing these outcomes in dementia.
在社区样本中，多种药物治疗与住院和死亡风险增加有关。它在痴呆症患者中很常见，但这些风险在该人群中很少被研究。我们旨在研究痴呆症患者多种药物治疗与急诊科就诊、任何和非计划性住院以及死亡率之间的关联。我们使用伦敦南部的一个大型精神卫生保健数据库，与住院和死亡率数据相关联，组建了一个痴呆症患者回顾性队列。我们确定了痴呆症诊断时开具的药物数量，并进行了多变量 Cox 回归分析。在确定的 4668 名痴呆症患者中，有 1128 名（24.2%）患者开具了 4-6 种药物，739 名（15.8%）患者开具了≥7 种药物。与使用 0-3 种药物的患者相比，使用 4-6 种或≥7 种药物的痴呆症患者急诊科就诊（风险比 1.20/1.35）、住院（风险比 1.12/1.32）、非计划性住院（风险比 1.12/1.25）和两年内死亡（风险比 1.29/1.39）的风险增加，在控制了潜在混杂因素后。我们发现了与每种额外药物相关的剂量反应关系的证据，基线时每增加一种药物，急诊科就诊和死亡率的风险增加 5%，住院的风险增加 3%。总之，痴呆症诊断时的多种药物治疗与不良健康结果的风险增加有关。需要进一步研究阐明哪些特定药物是这种关系的基础，以及减少不适当的处方是否能有效预防痴呆症患者的这些结局。
