Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, United Kingdom.
Department of Elderly Medicine, Brighton and Sussex University Hospitals National Health Service Trust, Sussex, United Kingdom.
J Am Geriatr Soc. 2018 Sep;66(9):1812-1822. doi: 10.1111/jgs.15419. Epub 2018 Jul 4.
To determine the incidence, severity, and preventability of and risk factors for medication-related harm (MRH) in community-dwelling older adults after hospital discharge.
Systematic review.
A search of Medline, EMBASE, CINAHL, and the Cochrane Library was undertaken without time restrictions.
Older adults (average age ≥65) participating in observational studies investigating postdischarge adverse drug reactions (ADRs) or adverse drug events (ADEs) within a defined follow-up period.
One author screened abstracts of all articles to exclude obviously irrelevant articles. Two authors independently screened the remaining articles for inclusion. Two authors independently extracted data, including study characteristics, MRH incidence, and risk factors; a third reviewer critically appraised and verified the data. Disagreements were resolved through discussion.
From 584 potentially relevant articles, 8 studies met our inclusion criteria: 5 North American and 3 European. Most of the included studies were of moderate quality. There was a wide range in MRH incidence, from 0.4% to 51.2% of participants, and 35% to 59% of MRH was preventable. MRH incidence within 30 days after discharge ranged from 167 to 500 events per 1,000 individuals discharged (17-51% of individuals). There is substantial methodological heterogeneity across multiple domains of the studies, including ADR and ADE definitions, characteristics of recruited populations, follow-up duration after discharge, and data collection.
MRH is common after hospital discharge in older adults, but methodological inconsistencies between studies and a paucity of data on risk factors limits clear understanding of the epidemiology. There is a need for international consensus on conducting and reporting MRH studies. Data from large, multicenter studies examining a range of biopsychosocial risk factors could provide insight into this important area of safety.
确定出院后社区居住的老年人药物相关伤害（MRH）的发生率、严重程度、可预防程度和危险因素。
系统评价。
无时间限制地搜索了 Medline、EMBASE、CINAHL 和 Cochrane 图书馆。
参与观察性研究的老年人（平均年龄≥65 岁），这些研究在规定的随访期内调查了出院后不良反应（ADR）或不良药物事件（ADE）。
一位作者筛选了所有文章的摘要以排除明显不相关的文章。两位作者独立筛选其余文章以纳入。两位作者独立提取数据，包括研究特征、MRH 发生率和危险因素；第三位审稿人批判性地评估并验证了数据。通过讨论解决了分歧。
从 584 篇潜在相关文章中，有 8 篇研究符合我们的纳入标准：5 篇来自北美，3 篇来自欧洲。大多数纳入的研究质量中等。MRH 发生率差异很大，从参与者的 0.4%到 51.2%，35%到 59%的 MRH 是可以预防的。出院后 30 天内 MRH 发生率范围为每 1000 名出院患者中有 167 至 500 例事件（17-51%的患者）。多项研究在多个领域存在方法学异质性，包括 ADR 和 ADE 定义、招募人群特征、出院后随访时间和数据收集。
老年人出院后 MRH 很常见，但研究之间方法学不一致以及缺乏危险因素数据限制了对流行病学的清晰理解。需要就进行和报告 MRH 研究达成国际共识。来自大型、多中心研究的关于一系列生物心理社会危险因素的数据可以为这一重要安全领域提供深入了解。
