描述非常高龄老年人的多重用药情况：纽卡斯尔 85+ 研究的结果。
Characterising polypharmacy in the very old: Findings from the Newcastle 85+ Study.
机构信息
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.
出版信息
PLoS One. 2021 Jan 19;16(1):e0245648. doi: 10.1371/journal.pone.0245648. eCollection 2021.
BACKGROUND
Polypharmacy is potentially harmful and under-researched amongst the fastest growing subpopulation, the very old (aged ≥85). We aimed to characterise polypharmacy using data from the Newcastle 85+ Study-a prospective cohort of people born in 1921 who turned 85 in 2006 (n = 845).
METHODS
The prevalence of polypharmacy at baseline (mean age 85.5) was examined using cut-points of 0, 1, 2-4, 5-9 and ≥10 medicines-so-called 'no polypharmacy', 'monotherapy', 'minor polypharmacy', 'polypharmacy' and 'hyperpolypharmacy.' Cross-tabulations and upset plots identified the most frequently prescribed medicines and medication combinations within these categories. Mixed-effects models assessed whether gender and socioeconomic position were associated with prescribing changes over time (mean age 85.5-90.5). Participant characteristics were examined through descriptive statistics.
RESULTS
Complex multimorbidity (44.4%, 344/775) was widespread but hyperpolypharmacy was not (16.0%, 135/845). The median medication count was six (interquartile range 4-8). Preventative medicines were common to all polypharmacy categories, and prescribing regimens were diverse. Nitrates and oral anticoagulants were more frequently prescribed for men, whereas bisphosphonates, non-opioid analgesics and antidepressants were more common in women. Cardiovascular medicines, including loop diuretics, tended to be more frequently prescribed for socioeconomically disadvantaged people (<25th centile Index of Multiple Deprivation (IMD)), despite no difference in the prevalence of cardiovascular disease (p = 0.56) and diabetes (p = 0.92) by IMD.
CONCLUSION
Considering their complex medical conditions, prescribing is relatively conservative amongst 85-year-olds living in North East England. Prescribing shows significant gender and selected socioeconomic differences. More support for managing preventative medicines, of uncertain benefit, might be helpful in this population.
背景
在增长最快的老年人群体（年龄≥85 岁）中，药物使用种类过多（即同时使用多种药物）可能有害且研究不足。我们旨在使用 2006 年出生于 1921 年且年满 85 岁的纽卡斯尔 85+研究的前瞻性队列研究数据来描述药物使用种类过多的情况（n=845）。
方法
使用 0、1、2-4、5-9 和≥10 种药物的切点来检查基线时（平均年龄 85.5 岁）的药物使用种类过多的患病率，这些切点被称为“无药物使用种类过多”、“单药治疗”、“轻度药物使用种类过多”、“药物使用种类过多”和“超药物使用种类过多”。交叉表和打乱图确定了这些类别中最常开的药物和药物组合。混合效应模型评估了性别和社会经济地位是否与随时间的处方变化相关（平均年龄 85.5-90.5 岁）。通过描述性统计分析研究参与者的特征。
结果
复杂的多病共存（44.4%，344/775）很普遍，但超药物使用种类过多并不常见（16.0%，135/845）。药物计数中位数为 6（四分位距 4-8）。预防药物在所有药物使用种类过多的类别中都很常见，而处方方案多种多样。硝酸盐和口服抗凝剂更常为男性开处方，而双膦酸盐、非阿片类镇痛药和抗抑郁药更常见于女性。心血管药物，包括袢利尿剂，更常为社会经济地位较低的人（<25%的多因素剥夺指数（IMD））开处方，尽管按 IMD 划分，心血管疾病（p=0.56）和糖尿病（p=0.92）的患病率没有差异。
结论
考虑到他们复杂的医疗状况，居住在英格兰东北部的 85 岁老年人的处方相对保守。处方存在显著的性别和部分社会经济差异。在这一人群中，可能需要更多的支持来管理不确定益处的预防药物。
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