Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
J Am Med Dir Assoc. 2019 Sep;20(9):1116-1120. doi: 10.1016/j.jamda.2019.01.130. Epub 2019 Mar 8.
To assess 1-year incidence and factors related to deprescribing in nursing home (NH) residents in Europe.
Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study.
NHs in Europe and Israel.
1843 NH residents on polypharmacy.
Polypharmacy was defined as the concurrent use of 5 or more medications. Deprescribing was defined as a reduction in the number of medications used over the study period. Residents were followed for 12 months.
Residents in the study sample were using a mean number of 8.6 (standard deviation 2.9) medications at the baseline assessment. Deprescribing was observed in 658 residents (35.7%). Cognitive impairment (mild/moderate impairment vs intact, odds ratio [OR] 1.41, 95% confidence interval [CI] 1.11-1.79; severe impairment vs intact, OR 1.60, 95% CI 1.23-2.09), presence of the geriatrician within the facility staff (OR 1.41, 95% CI 1.15-1.72), and number of medications used at baseline (OR 1.10, 95% CI 1.06-1.14) were associated with higher probabilities of deprescribing. In contrast, female gender (OR 0.76, 95% CI 0.61-0.96), heart failure (OR 0.69, 95% CI 0.53-0.89), and cancer (OR 0.64, 95% CI 0.45-0.90) were associated with a lower probability of deprescribing.
Deprescribing is common in NH residents on polypharmacy, and it is associated with individual and organizational factors. More evidence is needed on deprescribing, and clear strategies on how to withdraw medications should be defined in the future.
评估欧洲疗养院（NH）居民一年内药物减量及其相关因素。
基于 Services and Health for Elderly in Long TERm care（SHELTER）研究数据的纵向多中心队列研究。
欧洲和以色列的 NH。
1843 名服用多种药物的 NH 居民。
多种药物治疗定义为同时使用 5 种或更多药物。药物减量定义为在研究期间减少使用的药物数量。居民随访 12 个月。
研究样本中的居民在基线评估时平均使用 8.6 种（标准差 2.9）药物。有 658 名（35.7%）居民进行了药物减量。认知障碍（轻度/中度障碍与完整认知相比，比值比[OR]1.41，95%置信区间[CI]1.11-1.79；严重障碍与完整认知相比，OR 1.60，95% CI 1.23-2.09）、机构工作人员中有老年病医生（OR 1.41，95% CI 1.15-1.72）和基线时使用的药物数量（OR 1.10，95% CI 1.06-1.14）与更高的药物减量可能性相关。相比之下，女性（OR 0.76，95% CI 0.61-0.96）、心力衰竭（OR 0.69，95% CI 0.53-0.89）和癌症（OR 0.64，95% CI 0.45-0.90）与药物减量的可能性较低相关。
服用多种药物的 NH 居民中药物减量很常见，与个人和组织因素有关。需要更多关于药物减量的证据，未来应明确如何停药的策略。
