Gutiérrez-Valencia Marta, Izquierdo Mikel, Lacalle-Fabo Esther, Marín-Epelde Itxaso, Ramón-Espinoza María Fernanda, Domene-Domene Thamara, Casas-Herrero Álvaro, Galbete Arkaitz, Martínez-Velilla Nicolás
Department of Geriatrics, Complejo Hospitalario de Navarra, C/Irunlarrea 3, 31008, Pamplona, Spain.
IdiSNa, Navarra Institute for Health Research, Pamplona, Navarra, Spain.
Eur J Clin Pharmacol. 2018 Jul;74(7):961-970. doi: 10.1007/s00228-018-2452-2. Epub 2018 Mar 27.
Frailty, polypharmacy, and underprescription are considered a major matter of concern in nursing homes, but the possible relationships between them are not well known. The aim is to examine the possible association between medication underprescription, polypharmacy, and frailty in older people living in nursing homes.
A cross-sectional analysis from a concurrent cohort study, including 110 subjects ≥ 65 years living in two nursing homes. Four frailty scales were applied; polypharmacy was defined as ≥ 5 medications and underprescription was measured with Screening Tool to Alert to Right Treatment (START) criteria. Logistic regression models were performed to assess the associations.
The mean age was 86.3 years (SD 7.3) and 71.8% were female. 73.6% of subjects took ≥ 5 chronic medications and 60.9% met one or more START criteria. The non-frail participants took more medications than the frail subjects according to the imputated frailty Fried criteria (8.1 vs 6.7, p = 0.042) and the FRAIL-NH scale (7.8 vs 6.8, p = 0.026). Multivariate analyses did not find an association between frailty and polypharmacy. Frail participants according to the Fried criteria met a higher number of START criteria (1.9 vs 1.0, p = 0.017), and had a higher prevalence of underprescription (87.5 vs 50.0%), reaching the limit of statistical significance in multivariate analysis.
The positive association found in previous studies between frailty and polypharmacy cannot be extrapolated to institutionalized populations. There is a trend towards higher rates of underprescription in frail subjects. Underprescription in frail older adults should be redefined and new strategies to measure it should be developed.
衰弱、多重用药和处方不足被认为是养老院中一个主要的关注问题，但它们之间可能的关系尚不为人所知。目的是研究养老院中老年人用药处方不足、多重用药与衰弱之间可能存在的关联。
对一项同期队列研究进行横断面分析，纳入了110名居住在两家养老院的65岁及以上老人。应用了四种衰弱量表；多重用药定义为服用≥5种药物，处方不足用“正确治疗警报筛查工具”（START）标准进行衡量。采用逻辑回归模型评估关联。
平均年龄为86.3岁（标准差7.3），女性占71.8%。73.6%的受试者服用≥5种慢性药物，60.9%符合一项或多项START标准。根据估算的衰弱弗里德标准（8.1对6.7，p = 0.042）和FRAIL-NH量表（7.8对6.8，p = 0.026），非衰弱参与者服用的药物比衰弱受试者更多。多变量分析未发现衰弱与多重用药之间存在关联。根据弗里德标准，衰弱参与者符合START标准的数量更多（1.9对1.0，p = 0.017），且处方不足的患病率更高（87.5%对50.0%），在多变量分析中达到统计学意义的极限。
先前研究中发现的衰弱与多重用药之间的正相关不能外推至机构化人群。衰弱受试者存在处方不足率更高的趋势。应重新定义衰弱老年人的处方不足，并制定新的测量策略。
