Hukins Deborah, Macleod Una, Boland Jason W
Wolfson Centre for Palliative Care Research, Hull York Medical School, University of Hull, Hull, UK.
Eur J Clin Pharmacol. 2019 Apr;75(4):467-481. doi: 10.1007/s00228-018-02612-x. Epub 2019 Jan 4.
Older people with dementia are at risk of adverse events associated with potentially inappropriate prescribing.
to describe (1) how international tools designed to identify potentially inappropriate prescribing have been used in studies of older people with dementia, (2) the prevalence of potentially inappropriate prescribing in this cohort and (3) advantages/disadvantages of tools METHODS: Systematic literature review, designed and reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, EMBASE, PsychInfo, CINAHL, the Cochrane Library, the Social Science Citation Index, OpenGrey, Base, GreyLit, Mednar and the National Database of Ageing Research were searched in April 2016 for studies describing the use of a tool or criteria to identify potentially inappropriate prescribing in older people with dementia.
Three thousand three hundred twenty-six unique papers were identified; 26 were included in the review. Eight studies used more than one tool to identify potentially inappropriate prescribing. There were variations in how the tools were applied. The Beers criteria were the most commonly used tool. Thirteen of the 15 studies using the Beers criteria did not use the full tool. The prevalence of potentially inappropriate prescribing ranged from 14 to 74% in older people with dementia. Benzodiazepines, hypnotics and anticholinergics were the most common potentially inappropriately prescribed medications.
Variations in tool application may at least in part explain variations in potentially inappropriate prescribing across studies. Recommendations include a more standardised tool usage and ensuring the tools are comprehensive enough to identify all potentially inappropriate medications and are kept up to date.
患有痴呆症的老年人面临与潜在不适当处方相关的不良事件风险。
描述（1）旨在识别潜在不适当处方的国际工具在老年痴呆症患者研究中的使用方式，（2）该队列中潜在不适当处方的患病率，以及（3）工具的优点/缺点。方法：系统文献综述，根据系统评价和Meta分析方案的首选报告项目（PRISMA-P）进行设计和报告。2016年4月，对MEDLINE、EMBASE、PsychInfo、CINAHL、Cochrane图书馆、社会科学引文索引、OpenGrey、Base、GreyLit、Mednar和国家老龄化研究数据库进行了检索，以查找描述使用工具或标准识别老年痴呆症患者潜在不适当处方的研究。
共识别出3326篇独特的论文；26篇被纳入综述。八项研究使用了不止一种工具来识别潜在不适当的处方。工具的应用方式存在差异。Beers标准是最常用的工具。使用Beers标准的15项研究中有13项未使用完整工具。老年痴呆症患者中潜在不适当处方的患病率在14%至74%之间。苯二氮䓬类药物、催眠药和抗胆碱能药物是最常见的潜在不适当处方药物。
工具应用的差异可能至少部分解释了不同研究中潜在不适当处方的差异。建议包括更标准化的工具使用，并确保工具足够全面，能够识别所有潜在不适当的药物，并及时更新。
