难以下咽的苦药——晚期痴呆患者的多种药物治疗和精神类药物治疗。
A bitter pill to swallow - Polypharmacy and psychotropic treatment in people with advanced dementia.
机构信息
School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
School of Medicine, Hospital Pharmacy, Technical University of Munich, Munich, Germany.
出版信息
BMC Geriatr. 2022 Mar 16;22(1):214. doi: 10.1186/s12877-022-02914-x.
BACKGROUND
Polypharmacy is common in people with dementia. The use of psychotropic drugs (PDs) and other, potentially inappropriate medications is high. The aims of this cross-sectional study were 1) to investigate the use of drugs in people with advanced dementia (PWAD), living at home or in long term care (LTC); 2) to focus on PD use; and 3) to identify determinants of PD use.
METHODS
The study was performed in the context of EPYLOGE (IssuEs in Palliative care for people in advanced and terminal stages of YOD and LOD in Germany). 191 PWAD were included. All drugs that were administered at the date of the examination were recorded. Multiple logistic regression analysis identified determinants of PD use.
RESULTS
96% of PWAD received medication with a median number of four drugs. 49.7% received five or more drugs. According to the Beers Criteria 39% of PWAD ≥ 65 years received at least one potentially inappropriate medication. 79% of PWAD were treated with PDs. Older PWAD and PWAD living in LTC facilities received significantly more drugs than younger PWAD, and PWAD living at home, respectively. Dementia etiology was significantly associated with the use of antipsychotics, antidepressants and sedative substances. Place of living was associated with the use of pain medication. Behavioral disturbances were associated with the use of antipsychotics and sedative substances.
CONCLUSIONS
To mitigate the dangers of polypharmacy and medication related harm, critical examination is required, whether a drug is indicated or not. Also, the deprescribing of drugs should be considered on a regular basis.
TRIAL REGISTRATION
Clinicaltrial.gov, NCT03364179 . Registered 6 December 2017.
背景
痴呆患者普遍存在多种药物治疗（polypharmacy）的情况。使用精神药物（psychotropic drugs，PDs）和其他潜在不适当的药物的情况也很高。本横断面研究的目的是：1）调查居家或长期护理（long term care，LTC）环境下，处于晚期痴呆（advanced dementia，PWAD）的患者的药物使用情况；2）重点关注 PD 的使用情况；3）确定 PD 使用的决定因素。
方法
本研究在 EPYLOGE（德国晚期和终末期 YOD 和 LOD 患者姑息治疗中的问题）的背景下进行。纳入了 191 例 PWAD。记录了检查当日所有给予的药物。采用多变量逻辑回归分析确定 PD 使用的决定因素。
结果
96%的 PWAD 接受了药物治疗，中位数为 4 种药物。49.7%的患者接受了 5 种或更多药物治疗。根据 Beers 标准，≥ 65 岁的 PWAD 中有 39%至少使用了一种潜在不适当的药物。79%的 PWAD 使用了 PD。年龄较大的 PWAD 和居住在 LTC 设施中的 PWAD 接受的药物明显多于年龄较小的 PWAD 和居家居住的 PWAD。痴呆病因与使用抗精神病药、抗抑郁药和镇静药物显著相关。居住地点与使用止痛药相关。行为障碍与使用抗精神病药和镇静药物相关。
结论
为了减轻药物治疗的危害，有必要对药物的适应证进行批判性的评估，也应定期考虑减少药物的使用。
临床试验注册
Clinicaltrial.gov，NCT03364179。于 2017 年 12 月 6 日注册。
Zotero 插件