Tanaka Asahi, Arai Yasumichi, Hirata Takumi, Abe Yukiko, Oguma Yuko, Urushihara Hisashi
Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University.
Center for Supercentenarian Medical Research, Keio University School of Medicine.
Nihon Ronen Igakkai Zasshi. 2019;56(4):504-515. doi: 10.3143/geriatrics.56.504.
To assess the burdens of polypharmacy and the drug burden index in community-dwelling elder people.
The survey was conducted on 396 participants who participated in The Kawasaki Wellbeing Project from March to December 2017. We investigated the associations between the drug burden and the physical/cognitive/mental outcomes. The drug burden was determined by calculating the number of medications and the drug burden index (DBI) based on the use of anticholinergic and sedative drugs. A multivariate regression analysis was conducted for the outcome measures ADL, IADL, MMSE, J-CHS, and EQ5D5L after adjusting for the sex, age, number of diseases, education level, smoking history, and alcohol history.
A total of 389 subjects were analyzed, the mean age of the population was 86 years old, and 187 people (48%) were male. Polypharmacy was reported in 243 people (62%), and DBI exposure was reported for 142 people (36.5%). We found that this population was physically healthy, with a median ADL of 100, and had high quality of life, with a median EQ5D5L of 0.895. Polypharmacy was found to be related to the J-CHS (β: 0.04) and EQ5D5L (-0.01). The DBI was also related to the EQ5D5L (-0.04).
These results showed that even though this population was healthier than the general Japanese elderly population, the drug burden of polypharmacy and high dosages of anticholinergic/sedative drugs exerted significant negative effects on frailty and the quality of life. Additional research should be conducted to investigate the long-term effects of polypharmacy and anticholinergic/sedative drugs on elderly people.
评估社区老年人多重用药负担及药物负担指数。
对2017年3月至12月参与川崎健康项目的396名参与者进行了调查。我们研究了药物负担与身体/认知/心理结果之间的关联。通过计算药物数量以及基于抗胆碱能和镇静药物使用情况的药物负担指数（DBI）来确定药物负担。在对性别、年龄、疾病数量、教育水平、吸烟史和饮酒史进行调整后，对日常生活活动能力（ADL）、工具性日常生活活动能力（IADL）、简易精神状态检查表（MMSE）、日本综合健康量表（J-CHS）和欧洲五维度健康量表（EQ5D5L）等结果指标进行了多元回归分析。
共分析了389名受试者，人群平均年龄为86岁，男性187人（48%）。243人（62%）报告存在多重用药情况，142人（36.5%）报告有DBI暴露。我们发现该人群身体健康，ADL中位数为100，生活质量较高，EQ5D5L中位数为0.895。发现多重用药与J-CHS（β：0.04）和EQ5D5L（-0.01）相关。DBI也与EQ5D5L（-0.04）相关。
这些结果表明，尽管该人群比一般日本老年人群更健康，但多重用药负担以及高剂量抗胆碱能/镇静药物对虚弱和生活质量产生了显著负面影响。应开展更多研究以调查多重用药以及抗胆碱能/镇静药物对老年人的长期影响。
