高血压老年非裔美国人潜在不适当药物使用。
Potentially inappropriate medication use among hypertensive older African-American adults.
机构信息
Charles R. Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA.
University of California, Los Angeles, USA.
出版信息
BMC Geriatr. 2018 Oct 5;18(1):238. doi: 10.1186/s12877-018-0926-9.
BACKGROUND
Inappropriate use of medications, particularly among minority older adults with co-morbidity, remains a major public health concern. The American Geriatrics Society (AGS) reports that Potentially Inappropriate Medication (PIM) continues to be prescribed for older adults, despite evidence of poor outcomes. The main objective of this study was to examine the prevalence of PIM use among underserved non-institutionalized hypertensive older African-American adults. Furthermore, this study examines potential correlations between PIM use and the number and type of chronic conditions.
METHODS
This cross-sectional study is comprised of a convenience sample of 193 hypertensive non-institutionalized African-American adults, aged 65 years and older recruited from several senior housing units located in underserved areas of South Los Angeles. The updated 2015 AGS Beers Criteria was used to identify participants using PIMs.
RESULTS
Almost one out of two participants had inappropriate medication use. While the average number of PIMs taken was 0.87 drugs, the range was from one to seven medications. Almost 23% of PIMs were due to drugs with potential drug-drug interactions. The most common PIM was the use of proton pump inhibitors (PPI) and Central Nervous System (CNS) active agents. Nearly 56% of PIMs potentially increased the risk of falls and fall-associated bone fractures. The use of PIMs was significantly higher among participants who reported a higher number of chronic conditions. Nearly 70% of participants with PIM use reported suffering from chronic pain.
CONCLUSIONS
The major reason for high levels of polypharmacy, PIMs, and drug interactions is that patients suffer from multiple chronic conditions. But it may not be possible or necessary to treat all chronic conditions. Therefore, the goals of care should be explicitly reviewed with the patient in order to determine which of the many chronic conditions has the greatest impact on the life goals and/or functional priorities of the patient. Those drugs that have a limited impact on the patient's functional priorities and that may cause harmful drug-drug interactions can be reduced or eliminated, while the remaining medications can focus on the most important functional priorities of the patient.
背景
药物的不当使用，尤其是在患有多种合并症的少数族裔老年人群中，仍然是一个主要的公共卫生关注点。美国老年医学会（AGS）报告称，尽管有不良后果的证据，但仍在为老年人开具潜在不适当药物（PIM）。这项研究的主要目的是检查在服务不足的非住院高血压老年非裔美国人中，PIM 的使用情况。此外，本研究还研究了 PIM 使用与慢性疾病数量和类型之间的潜在相关性。
方法
这项横断面研究包括从南洛杉矶服务不足地区的几个老年人住房单位招募的 193 名年龄在 65 岁及以上的高血压非住院非洲裔美国人的便利样本。使用 2015 年更新的 AGS Beers 标准来识别使用 PIM 的参与者。
结果
将近二分之一的参与者存在不适当的药物使用。虽然平均服用的 PIM 数量为 0.87 种药物，但范围从一种到七种药物。近 23%的 PIM 是由于具有潜在药物相互作用的药物引起的。最常见的 PIM 是质子泵抑制剂（PPI）和中枢神经系统（CNS）活性药物的使用。近 56%的 PIM 可能会增加跌倒和跌倒相关骨折的风险。报告患有更多慢性疾病的参与者使用 PIM 的比例明显更高。近 70%的 PIM 使用者报告患有慢性疼痛。
结论
导致高水平的多种药物治疗、PIM 和药物相互作用的主要原因是患者患有多种慢性疾病。但是，治疗所有慢性疾病可能并不可能或不必要。因此，应该与患者明确审查护理目标，以确定哪些慢性疾病对患者的生活目标和/或功能重点影响最大。那些对患者的功能重点影响有限且可能引起有害药物相互作用的药物可以减少或消除，而其余的药物可以专注于患者最重要的功能重点。
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