Geriatric Specialty Training School, University of Milan, Milan, Italy.
Geriatric Unit, Fondazione IRCCS Istituti Clinici Scientifici Maugeri, Via Camaldoli 64, 20138, Milan, Italy.
Intern Emerg Med. 2022 Jan;17(1):165-171. doi: 10.1007/s11739-021-02841-6. Epub 2021 Sep 21.
Polypharmacy represents a major clinical and public health issue in older persons. We aimed to measure the prevalence of polypharmacy, and the main predictors of drug prescription in nursing home residents. Post hoc analyses of the "Incidence of pNeumonia and related ConseqUences in nursing home Residents" (INCUR) study were conducted. Polypharmacy was defined as the prescription of 5 or more drugs. A frailty index (FI) was computed according to the model proposed by Rockwood and Mitnitski using 36 health deficits, including diseases, signs, symptoms, and disabilities. Linear regression models were performed to identify the main predictors of the number of prescribed drugs. The INCUR study enrolled 800 patients (mean [SD] age 86.2 [4.1] years, 74.1% women). The mean number of medications prescribed at the baseline was 8.5 (SD 4.1). Prevalence of polypharmacy was found 86.4%. The mean FI was 0.38 (SD 0.10). A fully adjusted linear multivariate regression model found an inverse and independent association between age and number of prescribed drugs (beta - 0.07, 95% CI - 0.13, - 0.02; p = 0.005). Conversely, the FI was independently and positively associated with the number of medications (beta 4.73, 95% CI 1.17, 8.29; p = 0.009). The prevalence of polypharmacy is high among older persons living in nursing home. Age and FI are significantly associated with the number of drugs. The number of prescribed drugs tends to decrease with age, whereas a direct association with frailty is reported.
老年人多病用药现象是一个主要的临床和公共卫生问题。本研究旨在评估养老院居民多病用药的流行情况，以及药物处方的主要预测因素。本研究是对“Incidence of pNeumonia and related ConseqUences in nursing home Residents”（INCUR）研究的事后分析。多病用药定义为开具 5 种或 5 种以上药物。根据 Rockwood 和 Mitnitski 提出的模型，使用 36 种健康缺陷（包括疾病、体征、症状和残疾）计算衰弱指数（FI）。采用线性回归模型确定药物处方数量的主要预测因素。INCUR 研究共纳入 800 名患者（平均[标准差]年龄 86.2[4.1]岁，74.1%为女性）。基线时开具的药物平均数量为 8.5（4.1）。多病用药的患病率为 86.4%。FI 的平均值为 0.38（0.10）。完全调整后的多元线性回归模型发现，年龄与开具药物数量之间存在负相关且独立的关系（β-0.07，95%CI-0.13，-0.02；p=0.005）。相反，FI 与开具的药物数量呈独立正相关（β4.73，95%CI1.17，8.29；p=0.009）。养老院中老年人多病用药的患病率较高。年龄和 FI 与药物数量显著相关。随着年龄的增长，开具的药物数量趋于减少，而与衰弱的直接关联则报告存在。
