Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland.
Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
Age Ageing. 2020 Jul 1;49(4):580-587. doi: 10.1093/ageing/afaa067.
Potentially inappropriate medication (PIM) use is prevalent in older adults and is associated with adverse events, hospitalisation and mortality. We assessed the patterns and associations of PIM use in older adults with mild-to-moderate Alzheimer's Disease (AD), who may represent a particularly vulnerable group.
Analysis of data from NILVad, an 18-month Randomised Control Trial of Nilvadapine in mild-to-moderate AD. The v2 STOPP criteria were applied in duplicate to identify PIM use. Associations between PIM use and adverse events/unscheduled healthcare visits in addition to the associations between PIM use and AD progression were evaluated.
448 older adults with mild-to-moderate AD from 23 centres in nine European countries.
Of 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) were prescribed a PIM with 30.1% being prescribed 2+ PIMs. The most frequent PIMs were (i) long-term benzodiazepines (11.6% N = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% N = 50/448), and (iii) Proton-Pump Inhibitors (PPIs) without appropriate indication (10.7% N = 48/448). Increasing number of PIMs was associated with a greater risk of adverse events (IRR 1.17, 1.13-1.19, P < 0.001), serious adverse events (IRR 1.27; 1.17-1.37, P < 0.001), unscheduled hospitalisations (IRR 1.16, 1.03-1.30, P = 0.016) and GP visits (IRR 1.22, 1.15-1.28, P < 0.001). PIM use was not associated with dementia progression.
PIM use is highly prevalent in mild-to-moderate AD and is associated with adverse events and unscheduled healthcare utilisation. Further attention to de-prescribing in this vulnerable group is warranted.
老年人中普遍存在潜在不适当用药（PIM），并与不良事件、住院和死亡有关。我们评估了轻度至中度阿尔茨海默病（AD）老年人中 PIM 使用的模式和相关性，这些患者可能代表一个特别脆弱的群体。
对 NILVad 的数据分析，这是一项针对轻度至中度 AD 的 Nilvadapine 的 18 个月随机对照试验。采用 v2 STOPP 标准重复两次以确定 PIM 使用。评估了 PIM 使用与不良事件/非计划性医疗就诊之间的关联，以及 PIM 使用与 AD 进展之间的关联。
来自欧洲 9 个国家 23 个中心的 448 名轻度至中度 AD 老年人。
448 名参与者（平均年龄：72.56 ± 8.19 岁）中，超过一半（55.8%）服用了 PIM，其中 30.1%服用了 2 种以上 PIM。最常见的 PIM 是（i）长期苯二氮䓬类药物（11.6%，N=52/448），（ii）无适当适应症的选择性 5-羟色胺再摄取抑制剂（11.1%，N=50/448）和（iii）无适当适应症的质子泵抑制剂（PPIs）（10.7%，N=48/448）。服用的 PIM 数量越多，不良事件的风险越高（IRR 1.17，1.13-1.19，P<0.001）、严重不良事件（IRR 1.27；1.17-1.37，P<0.001）、非计划性住院（IRR 1.16，1.03-1.30，P=0.016）和 GP 就诊（IRR 1.22，1.15-1.28，P<0.001）。PIM 使用与痴呆进展无关。
在轻度至中度 AD 中，PIM 使用非常普遍，并且与不良事件和非计划性医疗保健利用有关。在这个脆弱的群体中，进一步关注减药是必要的。
