School of Pharmacy, Keele University, Keele, UK
School of Pharmacy, Keele University, Keele, UK.
BMJ Open. 2020 Sep 14;10(9):e034346. doi: 10.1136/bmjopen-2019-034346.
Many central nervous system (CNS) medications are considered potentially inappropriate for prescribing in older people; however, these medications are common in polypharmacy (≥5 medicines) regimens. This paper aims to determine the prevalence of CNS drug classes commonly taken by older people. Furthermore, this paper aims to determine whether polypharmacy and other factors, previously found to be associated with overall polypharmacy, are associated with the most common CNS drug classes.
Cross-sectional study.
English Longitudinal Study of Ageing (wave 6).
7730 participants (≥50 years).
Adjusted Odds Ratios (OR) and 95% confidence intervals (CI) for CNS drug classes.
31% of the sample were currently taking ≥5 medications (polypharmacy), of whom 58% (n=1362/2356) were taking CNS medicines as part of their regimen. The most common CNS drug classes in polypharmacy regimens were non-opioid analgesics, opioid analgesics, tricyclic and related antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) (34.6%, 13.2%, 10.9% and 10.4%, respectively). Compared with people currently taking 1-4 prescribed medicines, polypharmacy was associated with adjusted ORs of 5.71 (95% CI: 4.29 to 7.61, p<0.01) for opioid analgesics, 3.80 (95% CI: 3.25 to 4.44, p<0.01) for non-opioid analgesics, 3.11 (95% CI: 2.43 to 3.98, p<0.01) for TCAs and 2.30 (95% CI: 1.83 to 2.89, p<0.01) for SSRIs. Lower wealth was also associated with the aforementioned CNS drug classes.
Opioid and non-opioid analgesics were the most prevalent classes of CNS medicines in this study. Polypharmacy is strongly associated with the aforementioned classes of analgesics. Polypharmacy is also associated with TCAs and SSRIs, although to a lesser extent than for analgesics. For all CNS medicine classes, polypharmacy may need to be considered in relation to reducing the risk of potential adverse events. After adjustment, lower wealth is associated particularly with analgesics, highlighting that socioeconomic factors may play a role in the prescribing of CNS medicines. These findings provide a baseline for future research into this area.
许多中枢神经系统 (CNS) 药物被认为不适合老年人开处方；然而，这些药物在多种药物治疗（≥5 种药物）方案中很常见。本文旨在确定老年人常用的 CNS 药物类别。此外，本文旨在确定是否与整体多种药物治疗相关的多药治疗和其他因素与最常见的 CNS 药物类别相关。
横断面研究。
英国老龄化纵向研究（第 6 波）。
7730 名参与者（≥50 岁）。
CNS 药物类别的调整后优势比 (OR) 和 95%置信区间 (CI)。
样本中有 31%的人目前正在服用≥5 种药物（多药治疗），其中 58%（n=1362/2356）正在服用 CNS 药物作为其治疗方案的一部分。多药治疗方案中最常见的 CNS 药物类别是非阿片类镇痛药、阿片类镇痛药、三环和相关抗抑郁药 (TCAs) 和选择性 5-羟色胺再摄取抑制剂 (SSRIs)（分别为 34.6%、13.2%、10.9%和 10.4%）。与目前服用 1-4 种处方药的人相比，多药治疗与阿片类镇痛药的调整后 OR 为 5.71（95%CI：4.29 至 7.61，p<0.01），非阿片类镇痛药为 3.80（95%CI：3.25 至 4.44，p<0.01），三环类抗抑郁药为 3.11（95%CI：2.43 至 3.98，p<0.01），SSRIs 为 2.30（95%CI：1.83 至 2.89，p<0.01）。较低的财富也与上述 CNS 药物类别有关。
阿片类和非阿片类镇痛药是本研究中最常见的 CNS 药物类别。多药治疗与上述类别的镇痛药密切相关。多药治疗也与三环类抗抑郁药和 SSRIs 相关，尽管程度较轻。对于所有 CNS 药物类别，可能需要考虑减少潜在不良事件的风险。调整后，较低的财富与镇痛药尤其相关，这突出表明社会经济因素可能在 CNS 药物的处方中发挥作用。这些发现为该领域的未来研究提供了基础。
