Department of Nursing Science, University of Eastern Finland, Kuopio, Finland; NeuroCentre, Neurology, Kuopio University Hospital, Kuopio, Finland.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Research Department of Practice and Policy, University College London School of Pharmacy, London, UK.
Dementia (London). 2020 Jul;19(5):1573-1585. doi: 10.1177/1471301218802675. Epub 2018 Oct 2.
The longitudinal pattern of medication use among family caregivers of people with dementia is not well understood, despite the potential for medication over- or under-use.
To investigate caregiver medication use over a five-year follow-up using data obtained via self-report and from a national prescription register, and compare agreement between medication data obtained from the two sources.
Medication data for 222 family caregivers of people with Alzheimer's disease were obtained via self-report and from the Finnish Social Insurance Institution. Generalised estimating equations, Kappa statistics and related samples Wilcoxon signed rank test were used to analyse medication use over time.
The mean number of medications used by caregivers increased from 3.4 to 4.1 (self-reported current regular medications) and 2.4 to 2.8 (reimbursed prescription medications during the past 90 days) over five years (p < 0.001). Significantly, more medications were identified via self-report (mean 3.6, SD = 3.3) than the national prescription register (mean 2.6, SD = 2.4, Z= -12.300, p < 0.001). Agreement between the two data sources was good for cardiovascular medications and anti-hypertensives (Kappa = 0.883-0.967, p < 0.001) and medications for acid-related disorders (Kappa = 0.508-0.092, p < 0.001). Agreement was moderate for analgesics (Kappa = 0.281-0.477, p < 0.001) and psychotropics (Kappa = 0.281-0.562, p < 0.002). The proportion of caregivers using five or more medications increased from 27.5% to 44.6% (self-report), and 16.7% to 27.7% (register) (p < 0.001).
Caregivers use an increasing number of medications in the first five years of caring for persons with dementia, and self-report using a higher number of medications than data from the national prescription register suggest.
尽管可能存在用药过度或不足的情况，但人们对痴呆症患者家庭成员照顾者的长期用药模式仍了解甚少。
通过自我报告和全国处方登记处获得的数据，调查照顾者在五年随访期间的用药情况，并比较从这两个来源获得的用药数据的一致性。
通过自我报告和芬兰社会保险机构，获取 222 名阿尔茨海默病患者家庭成员照顾者的用药数据。使用广义估计方程、Kappa 统计量和相关样本 Wilcoxon 符号秩检验分析随时间推移的用药情况。
在五年内，照顾者使用的药物数量从 3.4 种增加到 4.1 种（自我报告的当前常规药物）和从 2.4 种增加到 2.8 种（过去 90 天内报销的处方药）（p<0.001）。值得注意的是，通过自我报告（平均值为 3.6，标准差=3.3）确定的药物数量明显多于全国处方登记处（平均值为 2.6，标准差=2.4，Z=-12.300，p<0.001）。两种数据源之间的一致性对于心血管药物和抗高血压药物（Kappa=0.883-0.967，p<0.001）和酸相关疾病药物（Kappa=0.508-0.092，p<0.001）较好。对于镇痛药（Kappa=0.281-0.477，p<0.001）和精神药物（Kappa=0.281-0.562，p<0.002），一致性为中等。使用五种或更多药物的照顾者比例从 27.5%增加到 44.6%（自我报告），从 16.7%增加到 27.7%（登记处）（p<0.001）。
在照顾痴呆症患者的头五年中，照顾者使用的药物数量不断增加，并且自我报告使用的药物数量高于全国处方登记处的数据，这表明了这一点。
