Kose Eiji, Hirai Toshiyuki, Seki Toshiichi
Department of Pharmacotherapy, School of Pharmacy, Nihon University, 7-7-1 Narashinodai, Funabashi-shi, Chiba, 274-8555, Japan.
Department of Pharmacy, Hitachinaka General Hospital, 20-1 Ishikawachou, Hitachinaka-shi, Ibaraki, 312-0057, Japan.
Int J Clin Pharm. 2018 Oct;40(5):1292-1299. doi: 10.1007/s11096-018-0718-5. Epub 2018 Aug 21.
Background Psychotropic drugs were associated with greater risks of adverse drug reactions, including lower the level of consciousness, cause cognitive dysfunction, relax muscles, cause hypotension and others. However, the effect of psychotropic drug use on rehabilitation outcomes is poorly documented in Japan. Objective To assess the association of increased psychotropic drugs during hospitalization with activities of daily living among elderly patients. Setting This study was conducted at the convalescent rehabilitation ward in the Hitachinaka General Hospital in Japan. Method This retrospective longitudinal cohort study included consecutive patients aged ≥ 65 years between 2010 and 2016. Participants were divided based on presence or absence of increased psychotropic drugs including benzodiazepines, antidepressants, antipsychotics, and antiepileptic drugs during hospitalization. Functional recovery was assessed by the Functional Independence Measure (FIM). Multivariate analyses were performed, adjusting for confounding factors. Main outcome measures Cognitive gain in the Functional Independence Measure. Results We included 631 participants (227 males, 404 females) with a median age of 78 years (interquartile range 73-84 years). Multiple regression analysis revealed that change in psychotropic drug use, cognitive FIM at admission, and age were independently and negatively correlated with cognitive FIM gain. Multiple logistic regression analysis indicated that the "Comprehension" and "Memory" items of the cognitive FIM gain were independently and negatively associated with increased psychotropic drug use. Conclusion Increased psychotropic drug use during hospitalization may predict limited the improvement of cognitive activities of daily living in geriatric patients.
背景 精神药物与更高的药物不良反应风险相关，包括意识水平降低、导致认知功能障碍、肌肉松弛、引起低血压等。然而，在日本，使用精神药物对康复结局的影响鲜有文献记载。目的 评估老年患者住院期间精神药物使用增加与日常生活活动之间的关联。地点 本研究在日本日立市综合医院的康复疗养病房进行。方法 这项回顾性纵向队列研究纳入了2010年至2016年间年龄≥65岁的连续患者。参与者根据住院期间是否增加使用包括苯二氮䓬类、抗抑郁药、抗精神病药和抗癫痫药在内的精神药物进行分组。通过功能独立性测量（FIM）评估功能恢复情况。进行多变量分析，对混杂因素进行校正。主要结局指标 功能独立性测量中的认知增益。结果 我们纳入了631名参与者（男性227名，女性404名），中位年龄为78岁（四分位间距73 - 84岁）。多元回归分析显示，精神药物使用的变化、入院时的认知FIM以及年龄与认知FIM增益呈独立负相关。多元逻辑回归分析表明，认知FIM增益的“理解”和“记忆”项目与精神药物使用增加呈独立负相关。结论 住院期间精神药物使用增加可能预示老年患者日常生活认知活动改善有限。
