Department of Pharmacy, Tan Tock Seng Hospital, Singapore.
Department of Geriatric Medicine, Changi General Hospital, Singapore.
Singapore Med J. 2019 Jun;60(6):298-302. doi: 10.11622/smedj.2018153. Epub 2018 Nov 29.
Polypharmacy and inappropriate prescribing are associated with negative health outcomes in the elderly. Several prescribing tools have been developed to assess medication appropriateness. Explicit (criteria-based) tools often do not take into account patients' preferences and comorbidities, and have little room for individualised clinical judgement.
A cross-sectional observational study was conducted in 243 elderly patients admitted to the Geriatric Medicine service in a Singapore tertiary hospital over one month. We incorporated an implicit (judgement-based) tool developed by Scott et al into a mnemonic, 'S-I-R-E', to assess medication appropriateness: S = symptoms ('Have symptoms resolved?'), I = indication ('Is there a valid indication?'), R = risks ('Do risks outweigh benefits?') and E = end of life ('Is there short life expectancy limiting clinical benefit?').
Inappropriate prescribing was present in 27.6% of patients. The most common reason for inappropriateness of medications was lack of valid indication (62.2%), followed by high risk-benefit ratio (20.7%). The most common medications that lacked valid indication were supplements and proton pump inhibitors. Polypharmacy was found in 93% of patients and was significantly associated with inappropriate prescribing (p = 0.047).
Inappropriate prescribing and polpharmacy are highly prevalent in the hospitalised elderly. The 'S-I-R-E' mnemonic can be used as a memory aid and practical framework to guide appropriate prescribing in the elderly.
老年人同时服用多种药物和不适当的处方与负面健康结果有关。已经开发出几种处方评估工具来评估药物的适当性。明确的（基于标准的）工具通常没有考虑到患者的偏好和合并症，并且几乎没有个体化临床判断的空间。
在一个月内，对新加坡一家三级医院老年医学科收治的 243 名老年患者进行了一项横断面观察性研究。我们将 Scott 等人开发的一种隐性（基于判断的）工具纳入一个助记符“S-I-R-E”中，以评估药物的适当性：S = 症状（“症状是否已缓解？”）、I = 适应症（“是否有明确的适应症？”）、R = 风险（“风险是否大于收益？”）和 E = 生命末期（“有限的临床获益是否限制了预期寿命？”）。
27.6%的患者存在不适当的处方。药物不适当的最常见原因是缺乏明确的适应症（62.2%），其次是高风险-效益比（20.7%）。最常见的缺乏明确适应症的药物是补充剂和质子泵抑制剂。93%的患者存在多药治疗，与不适当的处方显著相关（p=0.047）。
住院老年人中普遍存在不适当的处方和多药治疗。“S-I-R-E”助记符可用作记忆辅助工具和实用框架，指导老年人的适当处方。
