MacRae Clare, Henderson David Ag, Mercer Stewart W, Burton Jenni, De Souza Nicosha, Grill Paula, Marwick Charis, Guthrie Bruce
Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.
Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
BJGP Open. 2021 Dec 14;5(6). doi: 10.3399/BJGPO.2021.0167. Print 2021.
Care home residents often have multiple cognitive and physical impairments, and are at high risk of adverse drug events (ADEs).
To describe excessive polypharmacy and potentially inappropriate prescribing predisposing care home residents to ADEs.
DESIGN & SETTING: A cross-sectional analysis of all dispensed prescriptions for 147 care home residents in Tayside and Fife, Scotland.
Prevalence of excessive polypharmacy was examined using multilevel logistic regression, by modelling associations between individual and care home predictors with excessive polypharmacy (≥10 drugs). Prescribing of drugs known to increase the risk of eight clinically important ADE categories was examined. Drugs prescribed within each ADE category, for each resident, were counted.
In total, 32.3% ( = 1444/4468) of residents had excessive polypharmacy, which was more common in residents aged 70-74 years (adjusted odds ratio [aOR] 1.86, 95% confidence interval [CI] = 1.04 to 3.34) and 80-84 years (aOR 1.75, 95% CI = 1.01 to 3.02), living in a residential care home (aOR 1.50, 95% CI = 1.19 to 1.88), and located in Fife (aOR 1.37, 95% CI = 1.09 to 1.71). Excessive polypharmacy was less common in residents with dementia (aOR 0.73, 95% CI = 0.64 to 0.84), and 8.9% (95% CI = 5.9% to 11.6%) of the variation was attributable to care home predictors. Potentially inappropriate prescribing of ≥2 drugs was seen across all ADE categories, with highest prevalence seen in drugs predisposing to constipation (35.8%), sedation (27.7%), and renal injury (18.0%).
Excessive polypharmacy is common in care home residents and is associated with both individual and care home predictors. Potentially inappropriate prescribing of drugs that predisposed residents to all included ADE categories is common. Research is needed to support and evaluate safe care home prescribing practices.
养老院居民通常存在多种认知和身体障碍，发生药物不良事件（ADEs）的风险很高。
描述导致养老院居民发生ADEs的过度多重用药和潜在不适当处方情况。
对苏格兰泰赛德和法夫地区147名养老院居民的所有配药处方进行横断面分析。
采用多水平逻辑回归分析过度多重用药的患病率，通过对个体和养老院预测因素与过度多重用药（≥10种药物）之间的关联进行建模。研究已知会增加8种临床重要ADE类别风险的药物处方情况。对每位居民在每个ADE类别中开具的药物进行计数。
总体而言，32.3%（=1444/4468）的居民存在过度多重用药，在70 - 74岁（调整优势比[aOR] 1.86，95%置信区间[CI]=1.04至3.34）和80 - 84岁（aOR 1.75，95% CI = 1.01至3.02）的居民中更为常见，居住在寄宿养老院（aOR 1.50，95% CI = 1.19至1.88），以及位于法夫地区（aOR 1.37，95% CI = 1.09至1.71）。过度多重用药在患有痴呆症的居民中不太常见（aOR 0.73，95% CI = 0.64至0.84），8.9%（95% CI = 5.9%至11.6%）的差异可归因于养老院预测因素。在所有ADE类别中均可见≥2种药物的潜在不适当处方，在易导致便秘的药物中患病率最高（35.8%），其次是镇静药物（27.7%）和肾损伤药物（18.0%）。
过度多重用药在养老院居民中很常见，且与个体和养老院预测因素均有关联。易导致居民发生所有纳入的ADE类别的潜在不适当药物处方很常见。需要开展研究以支持和评估安全的养老院处方实践。
