School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia.
Drugs Aging. 2020 Apr;37(4):291-300. doi: 10.1007/s40266-019-00742-0.
Pain is common in older patients and management guidelines rarely consider the effect of multiple comorbidities and concurrent medications on analgesic selection.
The objectives of this study were to identify the prevalence and pattern of analgesic prescribing and associated factors in older patients with polypharmacy.
Older patients (aged ≥ 75 years) admitted to the Royal Adelaide Hospital between September 2015 and August 2016 and with polypharmacy were included and their comorbidities and medications prescribed at discharge were recorded. Drug Burden Index and Charlson Comorbidity Index were calculated. The number of medications that increased the risk of orthostatic hypotension were recorded. Logistic regression was used to compute the association between analgesic use and participant characteristics, and results were presented as odds ratios and 95% confidence intervals, adjusted for age, sex, Charlson Comorbidity Index, Drug Burden Index and orthostatic hypotension.
Over 15,000 admissions were identified, of which 1192 patients were included, 824 (69%) of whom were prescribed an analgesic medication. Paracetamol (used by 89% of analgesic users), opioids (34%) and adjuvants (17%) were used more frequently than non-steroidal anti-inflammatory drugs (8%). Analgesic users had a higher Drug Burden Index, were prescribed more medications and were less likely to be male compared with non-users. Charlson Comorbidity Index across the cohort was high (7.3 ± 1.9) but there was no difference between analgesic users and non-users, but analgesic users were more likely to have a documented diagnosis of osteoarthritis, osteoporosis and falls. Opioid use was associated with the Drug Burden Index, while adjuvant use was associated with orthostatic hypotension. Opioid use was associated with having a diagnosis of osteoporosis and falls.
In our cohort of poly-medicated elderly patients, prescription of analgesic medications was common, and these patients are likely to have an increased rate of adverse drug reactions and falls compared with those who were not prescribed analgesic medications.
疼痛在老年患者中很常见，管理指南很少考虑多种合并症和同时使用的药物对镇痛药物选择的影响。
本研究的目的是确定患有多种药物治疗的老年患者中镇痛药物的使用情况和相关因素。
纳入 2015 年 9 月至 2016 年 8 月期间入住阿德莱德皇家医院的年龄≥75 岁的老年患者，并记录他们出院时的合并症和所开药物。计算药物负担指数和 Charlson 合并症指数。记录增加体位性低血压风险的药物数量。使用逻辑回归计算镇痛药物使用与参与者特征之间的关联，并以比值比和 95%置信区间表示，调整年龄、性别、Charlson 合并症指数、药物负担指数和体位性低血压。
确定了超过 15000 次入院，其中 1192 例患者入选，824 例（69%）患者开了镇痛药物。与非甾体抗炎药（8%）相比，扑热息痛（89%的镇痛药物使用者使用）、阿片类药物（34%）和辅助药物（17%）使用更为频繁。与非使用者相比，镇痛药物使用者的药物负担指数更高，开的药物更多，且更不可能是男性。整个队列的 Charlson 合并症指数较高（7.3±1.9），但镇痛药物使用者与非使用者之间没有差异，但镇痛药物使用者更有可能有骨关节炎、骨质疏松症和跌倒的诊断记录。阿片类药物的使用与药物负担指数相关，而辅助药物的使用与体位性低血压相关。阿片类药物的使用与骨质疏松症和跌倒的诊断相关。
在我们的多药治疗老年患者队列中，镇痛药物的处方很常见，与未开具镇痛药物的患者相比，这些患者发生药物不良反应和跌倒的风险可能更高。
