老年人药物滥用与身体功能的关系：系统评价。
The Association Between Polypharmacy and Physical Function in Older Adults: a Systematic Review.
机构信息
Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany.
Helmholtz Zentrum München, Institute of Epidemiology, Neuherberg, Germany.
出版信息
J Gen Intern Med. 2019 Sep;34(9):1865-1873. doi: 10.1007/s11606-019-05106-3. Epub 2019 Jun 25.
BACKGROUND
Reduced physical function and polypharmacy (PPha) are two highly prevalent negative effects of aging, which are expected to increase more, since demographic aging is expected to grow rapidly within the next decades. Previous research suggests that polypharmacy (PPha) is a predictor of poor physical function and vice versa in older adults and therefore we conducted a systematic review of the literature to summarize and critically analyze the relationship between physical function and PPha and vice versa in older adults, in order to provide recent scientific evidence.
METHODS
We searched MEDLINE and Embase from their inception to 19th October 2018 for English-language observational studies or trials assessing the effect of PPha on physical function and vice versa in older adults. Two investigators independently extracted study data and assessed the quality of the studies, after having screened the available studies from the literature search. Any disagreement was resolved by consensus.
RESULTS
Eighteen observational studies met the inclusion criteria. Eight studies assessed the impact of physical function on PPha and ten studies assessed the impact of PPha on physical function. Regarding the studies with PPha measurements as the outcome, all of them, except for one, found that better physical function is associated with lower risk of PPha. Likewise, all the studies with physical function measurements as the outcome, except for one, suggested that PPha is associated with lower physical function.
DISCUSSION
Evidence examining the effect of PPha on physical function and vice versa in older adults suggests a strong bidirectional association between these two factors and clinicians should be aware of this strong relationship. The limitations of our study include the high variability in PPha definitions and physical function measures, and the treatment of PPha and physical function as constant instead of time-varying variables in the studies' analyses.
背景
身体机能下降和多重用药（PPha）是衰老的两个高度流行的负面影响，预计这两个问题在未来几十年内会更加严重，因为人口老龄化预计会迅速增长。先前的研究表明，多重用药（PPha）是老年人身体机能下降的一个预测因素，反之亦然，因此我们对文献进行了系统综述，以总结和批判性分析老年人身体机能与 Ppha 之间以及反之的关系，为当前的科学证据提供参考。
方法
我们检索了 MEDLINE 和 Embase 从成立到 2018 年 10 月 19 日的英语观察性研究或试验，评估了 Ppha 对老年人身体机能的影响以及反之的影响。两名调查员独立提取研究数据，并在筛选了文献检索中的可用研究后评估了研究的质量。任何分歧都通过共识解决。
结果
有 18 项观察性研究符合纳入标准。有 8 项研究评估了身体机能对 Ppha 的影响，有 10 项研究评估了 Ppha 对身体机能的影响。关于以 Ppha 测量为结果的研究，除了一项研究外，所有研究都发现更好的身体机能与较低的 Ppha 风险相关。同样，除了一项研究外，所有以身体机能测量为结果的研究都表明 Ppha 与较低的身体机能相关。
讨论
评估 Ppha 对身体机能的影响以及反之的研究证据表明，这两个因素之间存在强烈的双向关联，临床医生应该意识到这种强烈的关系。我们研究的局限性包括 Ppha 定义和身体机能测量的高度可变性，以及在研究分析中，将 Ppha 和身体机能视为固定而不是时变变量。
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