Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
J Am Med Dir Assoc. 2021 Dec;22(12):2559-2564. doi: 10.1016/j.jamda.2021.04.021. Epub 2021 May 21.
Laxatives are among the most prescribed medications to nursing home (NH) patients, and we evaluated the hypothesis that laxative agents could be prescribed as a result of a prescribing cascade. The aims of the study are (1) to investigate the use of laxative drugs in a large sample of Italian NHs and (2) to assess the relationship between medications that can induce constipation and laxative use.
Retrospective cross-sectional multicenter study.
Individuals living in long-term care NHs.
Study conducted in a sample of Italian long-term care NHs distributed throughout the country. Information on drug prescriptions, diseases and sociodemographic characteristics collected 4 times during 2018 and 2019.
Among the 2602 patients recruited from 27 NHs (mean age ± standard deviation: 88.4 ± 8.5; women: 1994, 76.6%), 1248 were receiving laxatives (48%). Parkinson disease, cerebrovascular disease, and hemiplegia were associated with laxative prescription, and diabetes was associated with a decrease. Benzodiazepines, anti-Parkinson dopaminergic agents, and antidepressants (tricyclic antidepressants and mirtazapine) were associated with laxative treatment in univariate and adjusted models. Tricyclic antidepressants users were 3 times more likely to be taking laxatives than nonusers (odds ratio 2.98, 95% confidence interval 1.31-6.77, P = .0093). A larger number of drugs that can induce constipation was associated with laxative use (P = .0003). In all, 2002 individuals had at least 2 different prescription times: from the first to the last visit laxative use rose from 46.1% to 49.9%. Time of stay was also associated with laxative use (P = .016).
Laxatives are among the most prescribed medications in Italian NHs. Medications that can induce constipation, such as antidepressants, anti-Parkinson dopaminergic agents, and benzodiazepines, are often used together with laxatives, and combinations of these drugs further increase the use of laxatives. Optimizing the prescription of psychotropic drugs could help reduce the "prescribing cascade" with laxatives. The length of stay in NHs is often proportional to laxative use and chronic treatment is very common.
泻药是养老院（NH）患者最常开的药物之一，我们评估了这样一种假设，即泻药的开处方可能是由于处方级联。本研究的目的是：（1）调查意大利 NH 中大量样本中泻药药物的使用情况；（2）评估可引起便秘的药物与泻药使用之间的关系。
回顾性横断面多中心研究。
居住在长期护理 NH 的个体。
在全国范围内分布的意大利长期护理 NH 样本中进行研究。在 2018 年和 2019 年的 4 次期间收集药物处方、疾病和社会人口统计学特征的信息。
从 27 个 NH 中招募了 2602 名患者（平均年龄±标准差：88.4±8.5；女性：1994 人，76.6%），其中 1248 人正在服用泻药（48%）。帕金森病、脑血管病和偏瘫与泻药处方相关，而糖尿病与泻药处方减少相关。苯二氮䓬类、抗帕金森多巴胺能药物和抗抑郁药（三环类抗抑郁药和米氮平）在单变量和调整模型中与泻药治疗相关。与非使用者相比，三环类抗抑郁药使用者服用泻药的可能性增加了 3 倍（比值比 2.98，95%置信区间 1.31-6.77，P=0.0093）。使用更多可引起便秘的药物与使用泻药相关（P=0.0003）。共有 2002 人至少有 2 次不同的处方时间：从第一次到最后一次就诊，泻药的使用率从 46.1%上升到 49.9%。停留时间也与泻药的使用相关（P=0.016）。
泻药是意大利 NH 中最常开的药物之一。可引起便秘的药物，如抗抑郁药、抗帕金森多巴胺能药物和苯二氮䓬类，常与泻药一起使用，这些药物的组合进一步增加了泻药的使用。优化精神药物的处方可以帮助减少与泻药相关的“处方级联”。NH 中的停留时间通常与泻药的使用成正比，长期治疗非常常见。
