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老年患者合理药物治疗的特点。

Specific features of rational pharmacotherapy in elderly patients.

机构信息

Department of Pharmacy, I M Sechenov First Moscow State Medical University, Moscow, Russian Federation.

Department of Nursing Management and Social Work, I M Sechenov First Moscow State Medical University, Moscow, Russian Federation

出版信息

Eur J Hosp Pharm. 2023 Nov;30(6):322-327. doi: 10.1136/ejhpharm-2021-002980. Epub 2021 Nov 18.

Abstract

OBJECTIVE

It is well-known that finding an optimum medication at the correct dose for elderly patients is challenging for the practitioner. This study aimed to examine the main trends in prescribing medications for elderly patients and their compliance with the principles of rational pharmacotherapy, and to establish the main factors affecting adherence to treatment in these patients.

METHODS

956 records of outpatients over 60 years of age were examined. The groups of medications prescribed, the dosage simultaneously prescribed to one patient, the structure of nosologies among elderly patients, and the frequency of side effects were studied. The second stage of the study with 147 patients involved examining the adherence to medications by elderly patients using the Brief Medication Questionnaire.

RESULTS

A total of 147 patients (79 (53.7%) women and 68 (46.3%) men) aged over 60 years who were taking ≥4 medications for primary and concomitant diseases were surveyed. The phenomenon of polypragmasy is clearly seen when prescribing pharmacotherapy to elderly patients. Thus, 39% of patients were prescribed 2-4 drugs simultaneously, 55.4% were prescribed ≥5 drugs, and only 5.6% were prescribed one type of medication. Consequently, 90.5% of patients did not comply with the prescribed regimen of drugs. The main reasons for low adherence to treatment were: the complexity of the drug regimen (72.1% of cases); the high cost of drugs (63.9%); lack of appropriate knowledge about disease (67.3%); and no understanding of the necessity for drug intake and the pharmacotherapeutic effect in a particular situation (61.9%).

CONCLUSION

Optimisation of pharmacotherapy for elderly and senile patients requires consideration of functional changes in the body, the peculiarities of the pharmacodynamics and pharmacokinetics of drugs prescribed, the presence of polymorbidity, the prevalence of polypragmasy, and the low adherence to treatment.

摘要

目的

众所周知,为老年患者找到最佳药物剂量是临床医生面临的挑战。本研究旨在研究为老年患者开处方药物的主要趋势及其是否符合合理药物治疗原则,并确定影响这些患者治疗依从性的主要因素。

方法

检查了 956 名 60 岁以上的门诊患者记录。研究了同时给一名患者开的药物种类、剂量、老年患者的疾病分类结构以及副作用的频率。第二阶段涉及使用简短药物问卷对 147 名老年患者的药物依从性进行检查。

结果

共调查了 147 名(79 名女性[53.7%]和 68 名男性[46.3%])年龄超过 60 岁的患者,这些患者正在服用≥4 种用于原发性和伴发性疾病的药物。在为老年患者开药物治疗处方时,明显存在多药并用的现象。因此,39%的患者同时服用 2-4 种药物,55.4%的患者服用≥5 种药物,只有 5.6%的患者服用一种药物。因此,90.5%的患者不遵守规定的药物治疗方案。治疗依从性低的主要原因有:药物治疗方案复杂(72.1%);药物费用高(63.9%);缺乏适当的疾病知识(67.3%);不了解药物摄入和特定情况下药物治疗效果的必要性(61.9%)。

结论

优化老年和老年患者的药物治疗需要考虑身体功能变化、所开药物的药效动力学和药代动力学特点、共病的存在、多药并用的普遍性以及治疗依从性低等问题。

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