College of Medicine and Health, University of Exeter, Exeter, Devon, UK
College of Medicine and Health, University of Exeter, Exeter, Devon, UK.
BMJ Open. 2020 Jan 2;10(1):e029172. doi: 10.1136/bmjopen-2019-029172.
Dementia frequently occurs alongside comorbidities. Coexisting conditions are often managed with multiple medications, leading to increased risk of potentially inappropriate medication and adverse drug reactions. We aimed to estimate prevalence of, and identify factors reported to be associated with, potentially inappropriate prescribing (PIP) for older individuals diagnosed with dementia.
We used a state-of-the-art review approach, selecting papers written in English and published from 2007 to January 2018. Publications were retrieved from Scopus and Web of Science databases. Inclusion criteria included a formal diagnosis of dementia, a formal classification of PIP and reported prevalence of PIP as an outcome. Random effects models were used to provide a pooled estimate of prevalence of PIP. The Appraisal tool for Cross-Sectional Studies (AXIS tool) was used to assess bias in the included studies.
The bibliographic search yielded 221 citations, with 12 studies meeting the inclusion criteria. The estimates of PIP prevalence for people living with dementia ranged from 14% to 64%. Prevalence was 31% (95% CI 9 to 52) in the community, and 42% (95% CI 30 to 55) in nursing/care homes. PIP included prescribing likely related to dementia (eg, hypnotics and sedative and cholinesterase inhibitors) and prescribing related to treatment of comorbidities (eg, cardiovascular drugs and non-steroidal anti-inflammatory medication). Higher levels of comorbidity were associated with increased risk of PIP; however, only one study investigated associations with specific comorbidities of dementia.
PIP remains a significant issue in healthcare management for people living with dementia. Higher levels of comorbidity are associated with increased prevalence of PIP, but the specific conditions driving this increase remain unknown. Further work is necessary to investigate PIP related to the presence of common comorbidities in patients living with dementia.
痴呆症常伴有合并症。共存疾病通常需要使用多种药物治疗，从而增加了潜在不适当药物和药物不良反应的风险。我们旨在评估诊断为痴呆症的老年人中潜在不适当处方（PIP）的流行程度，并确定报告与之相关的因素。
我们使用了最先进的综述方法，选择了 2007 年至 2018 年 1 月期间用英文撰写并发表的论文。从 Scopus 和 Web of Science 数据库中检索出版物。纳入标准包括正式的痴呆症诊断、PIP 的正式分类以及作为结果报告的 PIP 流行率。使用随机效应模型提供 PIP 流行率的汇总估计值。使用横断面研究评估工具（AXIS 工具）评估纳入研究的偏倚。
文献检索产生了 221 条引文，其中 12 项研究符合纳入标准。患有痴呆症的人群中 PIP 的流行率估计值从 14%到 64%不等。社区中 PIP 的流行率为 31%（95%CI 9 至 52），疗养院中 PIP 的流行率为 42%（95%CI 30 至 55）。PIP 包括与痴呆症相关的处方（例如，催眠药和镇静剂以及胆碱酯酶抑制剂）和与治疗合并症相关的处方（例如，心血管药物和非甾体抗炎药）。合并症的严重程度与 PIP 的风险增加相关；但是，只有一项研究调查了与痴呆症特定合并症的关联。
PIP 仍然是痴呆症患者医疗保健管理中的一个重大问题。合并症的严重程度与 PIP 的流行率增加相关，但导致这种增加的具体情况尚不清楚。需要进一步研究与痴呆症患者常见合并症相关的 PIP。
