HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Mercer Building, Lower Mercer Street, Dublin 2, Ireland.
Drugs Aging. 2019 May;36(5):461-470. doi: 10.1007/s40266-019-00646-z.
There is strong evidence that potentially inappropriate prescribing is associated with falls in older adults. Fall-related hospitalizations should trigger medication review.
The aim of this before-and-after cohort study was to explore patterns of relevant potentially inappropriate prescribing in older people with fall-related hospitalizations.
Data on older adults with hospitalizations for falls, fractures and syncope between 2012 and 2016 were collected from 44 general practices in Ireland. Fall-related prescribing was defined from the Screening Tool for Older Persons' Prescriptions (sedatives and vasodilators) and the Screening Tool to Alert doctors to Right Treatment (vitamin D). Prevalence of prescriptions were estimated from general practice and hospital discharge records. Mixed-effects logistic regression was conducted to compare the 12-month pre- and post-hospitalization periods.
Overall, 927 individuals (68% female, average age 81.2 years; standard deviation 8.6) were included, 45% of whom had a diagnosis of fracture, 28% had syncope, and 27% had a fall without fracture/syncope. After adjustment for covariates and practice clustering effects, both vitamin D and sedatives had higher odds of prescription post-hospitalization (adjusted odds ratio [aOR] 4.47, 95% confidence interval [CI] 2.09-9.54, and aOR 1.75, 95% CI 1.29-2.39, respectively). With adjustments for age and sex, having a fracture was associated with new initiation of vitamin D (aOR 2.81, 95% CI 1.76-4.46) and having syncope was associated with continuing on vasodilators (aOR 1.99, 95% CI 1.06-3.74). No factors were associated with new sedative initiation.
Fall-related potentially inappropriate prescribing is prevalent in older adults who have a history of falls, and continues after discharge from hospital. Future studies should investigate why such prescribing is initiated after a fall-related hospitalization, and explore interventions that could reduce such hazardous prescribing.
有强有力的证据表明，潜在不适当的处方与老年人跌倒有关。与跌倒相关的住院治疗应触发药物审查。
本前后对照队列研究旨在探讨与跌倒相关住院治疗的老年人中相关潜在不适当处方的模式。
从爱尔兰 44 家全科诊所收集了 2012 年至 2016 年因跌倒、骨折和晕厥住院的老年人的数据。从老年人用药筛查工具（镇静剂和血管扩张剂）和正确治疗警示医生用药筛查工具（维生素 D）中定义与跌倒相关的处方。从全科诊所和医院出院记录中估计处方的患病率。采用混合效应逻辑回归比较住院前后 12 个月的情况。
共有 927 人（68%为女性，平均年龄 81.2 岁，标准差 8.6）纳入研究，其中 45%有骨折诊断，28%有晕厥，27%有跌倒但无骨折/晕厥。调整协变量和实践聚类效应后，维生素 D 和镇静剂的处方在后住院期间的可能性更高（调整后的优势比 [aOR] 4.47，95%置信区间 [CI] 2.09-9.54 和 aOR 1.75，95% CI 1.29-2.39）。调整年龄和性别后，骨折与维生素 D 的新起始治疗相关（aOR 2.81，95% CI 1.76-4.46），晕厥与血管扩张剂的持续使用相关（aOR 1.99，95% CI 1.06-3.74）。没有因素与新镇静剂的起始相关。
有跌倒史的老年人中与跌倒相关的潜在不适当处方很常见，并且在出院后仍在继续。未来的研究应调查为什么在与跌倒相关的住院治疗后会开始这种处方，并探索可以减少这种危险处方的干预措施。
Zotero 插件