Hasan Syed Shahzad, Zaidi Syed Tabish Razi, Nirwan Jorabar Singh, Ghori Muhammad Usman, Javid Farideh, Ahmadi Keivan, Babar Zaheer-Ud-Din
Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK.
School of Healthcare, University of Leeds, Leeds LS2 9JT, UK.
J Clin Med. 2019 Aug 23;8(9):1292. doi: 10.3390/jcm8091292.
Both old age and institutionalization in aged care homes come with a significant risk of developing several long-term mental and neurological disorders, but there has been no definitive meta-analysis of data from studies to determine the pooled estimate of central nervous system (CNS) medicines use in aged care homes. We conducted this systematic review to summarize the use of CNS drugs among aged care homes residents.
MEDLINE, EMBASE, CINAHL, Scopus, and International Pharmaceutical Abstracts (IPA) databases were searched (between 1 January 2000 and 31 December 2018) to identify population-based studies that reported the use of CNS medicines in aged care homes. Pooled proportions (with 95% confidence interval), according to study location were calculated.
A total of 89 studies reported the use of CNS medicines use in aged care. The pooled estimate of CNS drugs use varied according to country (from 20.3% in Ireland to 49.0% in Belgium) and region (from 31.7% in North America to 42.5% in Scandinavia). The overall pooled estimate of psychotropic medicines use was highest in Europe (72.2%, 95% CI, 67.1-77.1%) and lowest in ANZ region (56.9%, 95% CI, 52.2-61.4%). The pooled estimate of benzodiazepines use varied widely from 18.9% in North America to 44.8% in Europe. The pooled estimate of antidepressants use from 47 studies was 38.3% (95% CI 35.1% to 41.6%) with highest proportion in North America (44.9%, 95% CI, 35.3-54.5%).
The overall use of CNS drugs varied among countries, with studies from Australia-New Zealand reported the lowest use of CNS drugs. The criteria for prescribing CNS drugs in clinical practice should be evidence-based. The criteria should be used not to prohibit the use of the listed medications but to support the clinical judgement as well as patient safety.
老年人以及入住养老院都存在患上多种长期精神和神经疾病的重大风险，但尚未有对相关研究数据进行的权威荟萃分析来确定养老院中中枢神经系统（CNS）药物使用的汇总估计值。我们进行了这项系统综述，以总结养老院居民中CNS药物的使用情况。
检索了MEDLINE、EMBASE、CINAHL、Scopus和国际药学文摘（IPA）数据库（2000年1月1日至2018年12月31日），以识别报告养老院中CNS药物使用情况的基于人群的研究。根据研究地点计算汇总比例（95%置信区间）。
共有89项研究报告了养老院中CNS药物的使用情况。CNS药物使用的汇总估计值因国家而异（从爱尔兰的20.3%到比利时的49.0%），也因地区而异（从北美的31.7%到斯堪的纳维亚的42.5%）。精神药物使用的总体汇总估计值在欧洲最高（72.2%，95%置信区间，67.1 - 77.1%），在澳新地区最低（56.9%，95%置信区间，52.2 - 61.4%）。苯二氮䓬类药物使用的汇总估计值差异很大，从北美的18.9%到欧洲的44.8%。47项研究中抗抑郁药使用的汇总估计值为38.3%（95%置信区间35.1%至41.6%），在北美比例最高（44.9%，95%置信区间，35.3 - 54.5%）。
各国CNS药物的总体使用情况各不相同，澳大利亚 - 新西兰的研究报告CNS药物使用量最低。临床实践中开具CNS药物的标准应以证据为基础。这些标准不应被用于禁止使用所列药物，而应支持临床判断以及患者安全。
