老年人痴呆症患者的药物相关问题。
Drug related problems in older adults living with dementia.
机构信息
Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
出版信息
PLoS One. 2020 Jul 31;15(7):e0236830. doi: 10.1371/journal.pone.0236830. eCollection 2020.
BACKGROUND
Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population.
METHODS
In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006-2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses.
RESULTS
Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics.
CONCLUSIONS
The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population.
背景
与没有痴呆的患者相比，入住急性护理环境的老年痴呆症患者更有可能同时使用三联药物（PP）、潜在不适当药物（PIM）和药物相互作用（DDI），这可能会对他们的健康造成损害。本研究旨在评估与住院老年痴呆症患者三联药物（PP）、PIM 和 DDI 相关的风险因素，并评估该人群中三联药物（PP）、PIM 和 DDI 的流行情况和特征。
方法
本回顾性横断面研究纳入了 2006 年至 2016 年期间在澳大利亚布里斯班的一家三级医院因痴呆症被转介至老年病专科会诊的 416 名老年住院患者。根据他们是否暴露于三联药物（PP）、PIM 和 DDI 组合，将患者分为两组：“三联组合”和“非三联组合”。使用 interRAI 急性护理（AC）评估工具收集数据。使用二变量和多变量逻辑回归分析评估暴露于三联组合的独立风险因素。
结果
总体而言，181 名（43.5%）患者被归类为三联组合组。大多数患者至少服用了一种 PIM（56%）或至少发生了一种潜在的 DDI（76%）。超过 75%的参与者接受了多药治疗。最常见的处方 PIM 是抗精神病药，其次是苯二氮䓬类药物。三联组合的独立风险因素是心房颤动诊断和更高的心脏治疗药物、精神药物和精神兴奋剂的使用。
结论
由于痴呆症患者的脆弱状况和药物使用不良事件的风险增加，他们更容易同时暴露于三联药物（PP）、PIM 和 DDI 中。本研究确定了心脏治疗药物、精神药物和精神兴奋剂的使用是暴露于三联药物（PP）、PIM 和 DDI 的预测因素。因此，应谨慎考虑并密切监测这些药物的使用。此外，应针对这一脆弱人群启动并持续实施全面的药物审查，以优化药物处方。
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