Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France.
J Am Geriatr Soc. 2019 Mar;67(3):455-462. doi: 10.1111/jgs.15717. Epub 2018 Dec 21.
To evaluate the chronicity of polypharmacy among older adults and to identify factors associated with chronic polypharmacy.
Longitudinal cohort study using register data.
Nationwide, Sweden.
All 711,432 older adults (aged 65 years and older) living in Sweden with five or more prescription drugs in October 2010 were included and followed up until December 2013. Mean age at baseline was 77 (SD = 7.8) years, 59% were women, and 7% lived in nursing homes.
Monthly changes in the exposure to polypharmacy. Data regarding prescription drug use were extracted from the Swedish Prescribed Drugs Register.
Overall, 82% were continuously exposed to polypharmacy for 6 months or longer, and 74% for 12 months or longer. The proportion of individuals who remained exposed until the end of the study was 55%. Among the 21,361 individuals who had not been exposed to polypharmacy during the 6-month period before baseline (ie, with a new episode of polypharmacy), only 30% remained exposed for 6 months or longer. The proportion of older adults who spent at least 80% of their follow-up time with polypharmacy was substantially higher among prevalent polypharmacy users at baseline than among those with a new polypharmacy episode (80% vs 24%; P < .01). Factors associated with chronic polypharmacy included higher age, female sex, living in an institution, chronic multimorbidity, and multidose dispensing.
Polypharmacy is most often chronic, although a substantial share of older adults experience short, recurring episodes of polypharmacy and are thus exposed to its potential harms in a transient rather than persistent manner. J Am Geriatr Soc 67:455-462, 2019.
评估老年人长期用药的情况，并确定与长期用药相关的因素。
使用登记数据的纵向队列研究。
瑞典全国范围。
2010 年 10 月，所有 711432 名瑞典年龄在 65 岁及以上、服用五种或以上处方药的老年人纳入研究并随访至 2013 年 12 月。基线时的平均年龄为 77（SD=7.8）岁，59%为女性，7%居住在养老院。
每月多药用药暴露情况的变化。处方药物使用数据从瑞典处方药物登记处提取。
总体而言，82%的患者持续暴露于多药用药 6 个月或更长时间，74%的患者持续暴露于多药用药 12 个月或更长时间。在研究结束时仍处于暴露状态的患者比例为 55%。在 21361 名基线前 6 个月未暴露于多药用药（即多药用药新发病例）的个体中，仅有 30%持续暴露 6 个月或更长时间。与基线时多药用药的新发患者相比，多药用药的持续暴露者（即，持续 6 个月或更长时间暴露于多药用药）在整个随访期间至少有 80%的时间使用多药用药的比例显著更高（80%对 24%；P<0.01）。与慢性多药用药相关的因素包括年龄较大、女性、居住在机构中、慢性多病共存和多剂量配药。
多药用药大多是慢性的，尽管相当一部分老年人经历短暂、反复的多药用药发作，因此其潜在危害是短暂的而不是持续的。美国老年学会杂志 67：455-462，2019。
