Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Department of Geriatrics, Catholic University of Rome, Italy.
Department of Geriatrics, Catholic University of Rome, Italy.
J Am Med Dir Assoc. 2018 Aug;19(8):710-713. doi: 10.1016/j.jamda.2018.04.008. Epub 2018 May 31.
To test the association between polypharmacy and 1-year change in physical and cognitive function among nursing home (NH) residents.
Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study.
NH in Europe (n = 50) and Israel (n = 7).
3234 NH older residents.
Participants were assessed through the interRAI long-term care facility instrument. Polypharmacy was defined as the concurrent use of 5 to 9 drugs and excessive polypharmacy as the use of ≥10 drugs. Cognitive function was assessed through the Cognitive Performance Scale (CPS). Functional status was evaluated through the Activities of Daily Living (ADL) Hierarchy scale. The change in CPS and ADL score, based on repeated assessments, was the outcome, and their association with polypharmacy was modeled via linear mixed models. The interaction between polypharmacy and time was reported [beta and 95% confidence intervals (95% CIs)].
A total of 1630 (50%) residents presented with polypharmacy and 781 (24%) excessive polypharmacy. After adjusting for potential confounders, residents on polypharmacy (beta 0.10, 95% CI 0.01-0.20) and those on excessive polypharmacy (beta 0.13, 95% CI 0.01-0.24) had a significantly higher decline in CPS score compared to those using <5 drugs. No statistically (P > .05) significant change according to polypharmacy status was shown for ADL score.
Polypharmacy is highly prevalent among older NH residents and, over 1 year, it is associated with worsening cognitive function but not functional decline.
检验 1 年内药物使用种类与养老院（NH）居民身体和认知功能变化之间的相关性。
基于 Services and Health for Elderly in Long TERm care（SHELTER）研究的数据，进行纵向多中心队列研究。
欧洲（n=50）和以色列（n=7）的 NH。
3234 名 NH 老年居民。
参与者通过 interRAI 长期护理机构工具进行评估。药物使用种类多定义为同时使用 5-9 种药物，药物使用种类过多定义为使用≥10 种药物。认知功能通过认知表现量表（CPS）进行评估。通过日常生活活动（ADL）层次量表评估功能状态。根据重复评估，CPS 和 ADL 评分的变化是结果，通过线性混合模型对其与药物使用种类多的关系进行建模。报告了药物使用种类多与时间之间的相互作用[β和 95%置信区间（95%CI）]。
共有 1630 名（50%）居民存在药物使用种类多，781 名（24%）居民药物使用种类过多。调整潜在混杂因素后，与使用<5 种药物的居民相比，使用药物种类多（β 0.10，95%CI 0.01-0.20）和药物使用种类过多（β 0.13，95%CI 0.01-0.24）的居民 CPS 评分下降幅度更大。根据药物使用种类多的状态，ADL 评分无统计学意义（P>.05）的变化。
药物使用种类多在老年 NH 居民中非常普遍，在 1 年内，它与认知功能恶化相关，但与功能下降无关。
