Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, New South Wales, Australia.
Department of Internal Medicine, New Haven, Connecticut.
J Gerontol A Biol Sci Med Sci. 2018 Sep 11;73(10):1410-1417. doi: 10.1093/gerona/gly078.
Use of potentially inappropriate medications (PIM) among people with dementia is common. We assessed the patterns of medication use from 1-year before dementia diagnosis, to 1-year after dementia diagnosis, compared with patterns of medication use in people without dementia.
We conducted longitudinal study using the National Alzheimer's Coordinating Center data. Adults aged 65 years and older newly diagnosed with dementia (n = 2,418) during 2005-2015 were year, age, and sex matched 1:1 with controls. Generalized estimating equation models weighted for missingness and adjusted for 15 participant characteristics were fit.
Among participants with dementia, number of medications reported 1-year prediagnosis was 8% lower than at diagnosis year (p < .0001) and 11% higher 1-year postdiagnosis compared with year of diagnosis (p < .0001). Among participants with dementia, the odds of PIM exposure, assessed using the 2015 Beers Criteria, was 17% lower 1-year prediagnosis (p < .0001) and 17% higher 1-year postdiagnosis (p = .006) compared with year of diagnosis. Among controls, there were approximately 6% more medications reported between consecutive years (p < .0001 each comparison) and the odds of PIM exposure increased 11% between consecutive years (p = .006 and p = .047). At each annual follow-up, participants with dementia had lower odds of PIM exposure than their controls (prediagnosis p < .0001, at diagnosis p = .0007, postdiagnosis p = .03, respectively). There were no differences in exposure to anticholinergic medications.
Number of medications and PIM use increased annually for participants with and without dementia. Persistent challenge of increasing PIM use in this group of older adults is of major concern and warrants interventions to minimize such prescribing.
痴呆患者中使用潜在不适当药物（PIM）很常见。我们评估了从痴呆诊断前 1 年到诊断后 1 年的药物使用模式，并与无痴呆患者的药物使用模式进行了比较。
我们使用国家阿尔茨海默病协调中心的数据进行了纵向研究。2005 年至 2015 年间新诊断为痴呆症的 65 岁及以上成年人（n=2418），按年龄、性别与对照者 1:1 匹配。使用广义估计方程模型，根据缺失值进行加权，并调整了 15 个参与者特征进行拟合。
在痴呆症患者中，诊断前 1 年报告的药物数量比诊断年减少 8%（p<0.0001），诊断后 1 年增加 11%（p<0.0001）。在痴呆症患者中，使用 2015 年 Beers 标准评估 PIM 暴露的可能性，诊断前 1 年降低 17%（p<0.0001），诊断后 1 年增加 17%（p=0.006）。在对照组中，连续几年报告的药物数量增加了约 6%（每次比较均<0.0001），PIM 暴露的可能性每年增加 11%（p=0.006 和 p=0.047）。在每年的随访中，痴呆症患者 PIM 暴露的可能性均低于对照组（诊断前 p<0.0001，诊断时 p=0.0007，诊断后 p=0.03）。抗胆碱能药物的暴露没有差异。
痴呆症患者和无痴呆症患者的药物数量和 PIM 使用每年都在增加。这组老年人中持续存在增加 PIM 使用的挑战，令人严重关切，需要采取干预措施，尽量减少此类处方。
