Pharmacology and Therapeutics Department, School of Medicine, Instituto de Investigación Biomédica de Málaga-IBIMA, University of Málaga, Campus de Teatinos, Boulevard Louis Pasteur, 32, 29071, Málaga, Spain.
Health District of Málaga-Guadalhorce, Málaga, Spain.
Eur J Clin Pharmacol. 2019 Oct;75(10):1459-1466. doi: 10.1007/s00228-019-02722-0. Epub 2019 Jul 24.
To comparatively assess the prevalence rates of potentially inappropriate medications (PIMs) obtained by the former and latest versions of American Geriatrics Society Beers Criteria (AGS BC) and screening tool of older person's potentially inappropriate prescriptions (STOPP), and analyze the factors of influence on PIM.
Cross-sectional study including 582 community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional, and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM.
A total of 3626 prescriptions were analyzed. PIMs were detected in 35.4% and 47.9% of patients according to the STOPP v1 and the 2012 AGS BC, respectively. This percentage rose to 54% when 2015 AGS BC were used and reached 66.8% with STOPP v2. The kappa coefficient between STOPP v2 and its former version was lower than the one between the updated Beers Criteria and their former version (0.41 vs 0.85). The agreement was good (0.65) between both latest criteria. The number of medications, psychological disorders, and insomnia were predictors of PIM. A novel finding was that bone and joint disorders increased the odds for PIM by 78%.
The 2015 AGS BC showed high sensitivity and good applicability to the European older patients. Both updated tools identified some pharmacological groups (benzodiazepines, PPIs, and opioids, among others) and certain health problems (insomnia, psychological disorders, and osteoarticular diseases) as factors of influence on PIM. Based on these findings, interventions aimed at promoting appropriate use of medications should be developed.
比较评估前版和最新版美国老年医学会（AGS）酒精标准（AGS BC）和老年人潜在不适当处方筛选工具（STOPP）得出的潜在不适当药物（PIM）的流行率，并分析影响 PIM 的因素。
这是一项包括 582 名 65 岁以上社区居住的老年人的横断面研究。收集了社会人口统计学、临床、功能和综合药物治疗数据。主要终点是接受至少一种 PIM 的患者比例。
共分析了 3626 份处方。根据 STOPP v1 和 2012 年 AGS BC，分别有 35.4%和 47.9%的患者存在 PIM。当使用 2015 年 AGS BC 时，这一比例上升至 54%，而当使用 STOPP v2 时则上升至 66.8%。STOPP v2 与其前一版本之间的 Kappa 系数低于更新后的 Beers 标准与其前一版本之间的 Kappa 系数（0.41 对 0.85）。这两个最新标准之间的一致性较好（0.65）。药物数量、心理障碍和失眠是 PIM 的预测因素。一个新发现是，骨骼和关节疾病使 PIM 的几率增加了 78%。
2015 年 AGS BC 对欧洲老年患者具有较高的敏感性和良好的适用性。这两种更新的工具都确定了一些药物组（苯二氮䓬类、质子泵抑制剂和阿片类药物等）和某些健康问题（失眠、心理障碍和骨关节炎疾病）是影响 PIM 的因素。基于这些发现，应该开发旨在促进适当使用药物的干预措施。
