氯硝西泮在患有精神疾病的老年人潜在不适当精神药物(PIP)清单中位居榜首:一项基于2019年Beers标准与2015年STOPP标准的横断面研究。

Clonazepam tops the list of potentially inappropriate psychotropic (PIP) medications in older adults with psychiatric illness: A cross-sectional study based on Beers criteria 2019 vs STOPP criteria 2015.

作者信息

Sharma Rishabh, Bansal Parveen, Sharma Arvind, Chhabra Manik, Bansal Nahush, Arora Malika

机构信息

Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, 142001, India.

University Centre of Excellence in Research, Baba Farid University of Health Sciences, Faridkot, Punjab, 151203, India.

出版信息

Asian J Psychiatr. 2021 Apr;58:102570. doi: 10.1016/j.ajp.2021.102570. Epub 2021 Feb 13.

Abstract

BACKGROUND

In older adults, polypharmacy and potentially inappropriate psychotropic (PIP) medication use are prominent prescription challenges. However, there is limited information available on the use of PIP medication in older adults having psychiatry illness.

OBJECTIVE

To find out the most commonly prescribed PIP in tertiary care hospitals of developing countries with respect to Beers criteria 2019 and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) and predictors of PIP.

METHODS

A cross-sectional analysis of 456 patients of either sex with a median age of 65 years visiting the outpatient department of psychiatry was performed at the tertiary care hospital of North India with respect to Beers criteria 2019 and STOPP criteria 2015. Bivariate logistic regression was used to figure out the predictors of PIP medication.

RESULTS

Results of the study reflects a staggering number of older adults, (more than 91 % and 73 %) out of total 456 patients were prescribed with at least one PIP medication as per Beers criteria and STOPP criteria, respectively. Long-acting benzodiazepine like clonazepam, chlordiazepoxide were identified as one of the most commonly prescribed PIP medications with respect to the both set of criteria. Further analysis revealed that polypharmacy (≥5 medications with odds Ratio (OR) 17.33, 95% Confidence Interval (CI) 1.42-210.66, P-0.025) as the sole important predictor for PIP medication.

CONCLUSION

According to the Beers criterion and the STOPP criteria, the use of PIP medicine is very prevalent among older adults with psychiatric illness. The Beers criteria dramatically diagnose more PIP medication than STOPP criteria.

摘要

背景

在老年人中,多重用药和潜在不适当的精神药物使用是突出的处方挑战。然而,关于患有精神疾病的老年人使用潜在不适当精神药物的信息有限。

目的

根据2019年《Beers标准》和《老年人潜在不适当处方筛查工具》(STOPP),找出发展中国家三级医院中最常开具的潜在不适当精神药物以及潜在不适当精神药物的预测因素。

方法

在印度北部的三级医院,对456名年龄中位数为65岁的精神科门诊患者进行了横断面分析,分析依据2019年《Beers标准》和2015年STOPP标准。采用二元逻辑回归来确定潜在不适当精神药物的预测因素。

结果

研究结果显示,在456名患者中,分别有超过91%和73%的老年人根据《Beers标准》和STOPP标准至少开具了一种潜在不适当精神药物。氯硝西泮、氯氮卓等长效苯二氮卓类药物被确定为根据这两套标准最常开具的潜在不适当精神药物之一。进一步分析表明,多重用药(≥5种药物,比值比(OR)为17.33,95%置信区间(CI)为1.42 - 210.66,P = 0.025)是潜在不适当精神药物的唯一重要预测因素。

结论

根据《Beers标准》和STOPP标准,潜在不适当精神药物在患有精神疾病的老年人中使用非常普遍。《Beers标准》诊断出的潜在不适当精神药物比STOPP标准多得多。

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