Pharmacy Department, Grup Mutuam, 08024 Barcelona, Spain.
School of Health Sciences Blanquerna, University Ramon Llull, 08025 Barcelona, Spain.
Int J Environ Res Public Health. 2019 Mar 15;16(6):934. doi: 10.3390/ijerph16060934.
Older people usually present with adverse drug events (ADEs) with nonspecific symptoms such as cognitive decline, recurrent falls, reduced mobility, and/or major deterioration. The aims of this study were to assess the ADEs of patients with dementia and presenting neuropsychiatric/behavioral, and psychological symptoms in dementia (BPSD) and to categorize and identify the principal factors that allow to prevent ADEs, and separately ADEs that result in falls. To that end, a one-year prospective study in a psychogeriatric ward (July 2015 to July 2016) was performed. All patients admitted to this ward were eligible for enrolment. Patients who met any of the following criteria were excluded from the study: Patients without cognitive impairment, a length of stay under 7 days, and palliative or previous psychiatric pathology. We included 65 patients (60% women, 84.9 years ± 6.7) with mild to moderate cognitive impairment, moderate to severe functional dependence, and a high prevalence of geriatric syndromes and comorbidity. A total of 87.7% were taking five or more drugs (mean 9.0 ± 3.1). ADEs were identified during the interdisciplinary meeting and the follow up by clinical record. Sixty-eight ADEs (81.5% patients) were identified, of which 73.5% were not related to falls. From these, 80% were related to drugs of the nervous system. The Naranjo algorithm determined that 90% of ADEs were probable. The severity of the ADEs was Category E in 34 patients (68%). The number of preventable ADE according to the Schumork⁻Thornton test was 58%. The main ADE was drowsiness/somnolence (27.7%). ADEs related to falls represented a 26.5%. The balance between effective treatment and safety is complex in these patients. A medication review in interdisciplinary teams is an essential component to optimize safety prevention.
老年人通常会出现药物不良反应（ADE），症状不典型，如认知能力下降、反复跌倒、活动能力降低和/或病情显著恶化。本研究旨在评估痴呆患者出现神经精神/行为和痴呆心理症状（BPSD）时的 ADE，并对可预防 ADE 及易导致跌倒的 ADE 进行分类和识别。为此，我们进行了一项为期一年的精神科病房前瞻性研究（2015 年 7 月至 2016 年 7 月）。所有入住该病房的患者均符合纳入标准。有以下任何一种情况的患者排除在研究之外：无认知障碍、住院时间少于 7 天、姑息治疗或既往有精神病史。共纳入 65 例患者（60%为女性，84.9 岁±6.7 岁），认知功能轻度至中度受损，中度至重度功能依赖，且老年综合征和共病的患病率较高。共有 87.7%的患者服用五种或五种以上药物（平均 9.0±3.1 种）。通过跨学科会议和临床记录随访来确定 ADE。共发现 68 例 ADE（81.5%的患者），其中 73.5%与跌倒无关。其中，80%的 ADE 与神经系统药物有关。Naranjo 算法确定 90%的 ADE 为可能。34 例患者（68%）的 ADE 严重程度为 E 类。Schumork-Thornton 试验确定的可预防 ADE 数量为 58%。主要 ADE 为嗜睡/昏睡（27.7%）。与跌倒相关的 ADE 占 26.5%。在这些患者中，有效治疗与安全性之间的平衡很复杂。在跨学科团队中进行药物审查是优化安全性预防的重要组成部分。
