Anand Pooja, Katyal Jatinder, Dey Aparajit Ballav, Gupta Yogendra Kumar
Department of Pharmacology All India Institute of Medical Sciences (AIIMS) New Delhi India.
Department of Geriatric Medicine All India Institute of Medical Sciences (AIIMS) New Delhi India.
Aging Med (Milton). 2022 Feb 5;5(1):45-52. doi: 10.1002/agm2.12194. eCollection 2022 Mar.
Polypharmacy is principal cause of potentially inappropriate medications (PIMs) in elderly patients, which include over prescribing, under prescribing, and misprescribing.
Elderly subjects (≥60 years), of either sex, receiving two or more medications for one or more chronic ailments, attending Geriatrics Outpatient Department (OPD), at All India Institute of Medical Sciences (AIIMS) New Delhi, were included. Their prescriptions were assessed for PIMs by using Beers criteria 2015 and were further followed up at least once in 6 months for adverse events, telephonically. The results were analyzed by using suitable regression models and correlation analysis.
Three hundred eighty patients average age of 65.4 ± 4.7 years were enrolled. Eighty-eight percent of the people were having greater than or equal to two ailments. Each patient was prescribed 6.7 ± 2.1 medications with 65% of prescriptions having one or more PIMs. Out of the total prescribed drugs, 15% were satisfying Beers criteria for PIMs. There were 63 adverse drug reactions (ADRs) reported. A statistically significant correlation was observed among comorbidities, number of prescribed medications, PIMs, and ADRs. Quality of life (QOL) of the elderly patients was negatively corelated with polypharmacy and female sex.
A risk-benefit analysis of prescribed medications is part and parcel of prescribing, especially in elderly patients. In order to decrease further risks associated with inappropriate prescribing, there is need for indigenous guidelines and intensive training.
多重用药是老年患者潜在不适当用药（PIMs）的主要原因，包括用药过量、用药不足和用药错误。
纳入年龄≥60岁、因一种或多种慢性疾病接受两种或更多药物治疗、在新德里全印度医学科学研究所（AIIMS）老年病门诊就诊的老年受试者（不限性别）。使用2015年Beers标准评估他们的处方中是否存在PIMs，并通过电话至少每6个月对不良事件进行一次随访。使用合适的回归模型和相关分析对结果进行分析。
共纳入380例患者，平均年龄65.4±4.7岁。88%的患者患有两种或两种以上疾病。每位患者平均开具6.7±2.1种药物，65%的处方存在一种或多种PIMs。在所有开具的药物中，15%符合PIMs的Beers标准。共报告了63例药物不良反应（ADR）。观察到合并症、开具药物数量、PIMs和ADR之间存在统计学显著相关性。老年患者的生活质量（QOL）与多重用药和女性性别呈负相关。
对开具的药物进行风险效益分析是处方的重要组成部分，尤其是在老年患者中。为了进一步降低与不适当处方相关的风险，需要制定本土指南并进行强化培训。
