School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
Department of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Drugs Aging. 2022 May;39(5):333-353. doi: 10.1007/s40266-022-00940-3. Epub 2022 May 22.
INTRODUCTION: Frailty is associated with an increased risk of death and morbid events. Frail individuals are known to have multiple comorbidities which are often associated with polypharmacy. Whilst a relationship between polypharmacy and frailty has been demonstrated, it is not clear if there is an independent relationship between frailty and medication harm. AIMS: This scoping review aimed to identify and critically appraise studies evaluating medication harm in patients with frailty. METHODS: PubMed, EMBASE, CINAHL and Cochrane databases were searched from inception until 1 February 2021 using key search terms that are synonymous with frailty (such as frail and frail elderly) and medication harm (such as adverse drug events and adverse drug reactions). To be included, studies must have identified medication harm as a primary or secondary outcome measure, and used a frailty assessment tool to determine frailty, or clearly defined how frailty was assessed. Data were narratively synthesised and presented in tables. The checklist from the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute was used to assess the quality and risk of bias of studies that met the inclusion criteria. RESULTS: Of 2685 retrieved abstracts, 24 underwent full-text review and nine studies met the inclusion criteria. Three studies were retrospective cohort studies, and six were prospective observational studies. Six studies comprised two distinct groups of frail and non-frail individuals, and the remaining three studies evaluated medication harm in an entirely frail population. Seven studies used validated frailty tools such as the Clinical Frailty Scale, Fried Frailty Index, and Fried Frailty Phenotype. Two studies measured frailty using self-defined criteria. Overall, frail individuals were at risk of medication harm with rates ranging between 18.7 and 77% across the nine studies. However, whether frailty is an independent predictor of medication harm remains uncertain, as this was only evaluated in one study. The risk of bias assessment identified limitations in methods and reporting with all nine studies. CONCLUSION: This scoping review identified nine studies evaluating medication harm in frail patients. However, all were limited by the methodological quality and inadequate reporting of study factors. There are few high-quality studies that described a relationship between medication harm and frailty. More robust studies are required that examine the independent relationship between frailty and medication harm, after adjusting for all possible confounders and in particular polypharmacy.
简介:衰弱与死亡和不良事件风险增加有关。众所周知,衰弱个体存在多种合并症,这些合并症通常与多种药物治疗有关。虽然已经证明了药物治疗与衰弱之间存在关系,但衰弱与药物不良反应之间是否存在独立关系尚不清楚。
目的:本范围综述旨在确定和批判性评价评估衰弱患者药物不良反应的研究。
方法:使用同义词(如虚弱和体弱老年人)和药物不良反应(如药物不良事件和药物不良反应)作为关键搜索词,从建库开始到 2021 年 2 月 1 日在 PubMed、EMBASE、CINAHL 和 Cochrane 数据库中进行搜索。纳入标准为:研究必须将药物不良反应确定为主要或次要结局测量指标,并且使用衰弱评估工具来确定衰弱,或者明确界定如何评估衰弱。数据以叙述性方式进行综合,并以表格形式呈现。使用来自美国国立心肺血液研究所的观察性队列研究和横断面研究质量评估工具检查表来评估符合纳入标准的研究的质量和偏倚风险。
结果:在 2685 篇检索到的摘要中,有 24 篇进行了全文审查,9 篇研究符合纳入标准。其中 3 项为回顾性队列研究,6 项为前瞻性观察性研究。有 6 项研究包含了虚弱和非虚弱两组个体,其余 3 项研究评估了完全虚弱人群中的药物不良反应。有 7 项研究使用了经过验证的衰弱工具,如临床虚弱量表、Fried 虚弱指数和 Fried 虚弱表型。有 2 项研究使用自我定义的标准来衡量虚弱。总体而言,在这 9 项研究中,虚弱个体发生药物不良反应的风险为 18.7%至 77%。然而,衰弱是否是药物不良反应的独立预测因素尚不确定,因为这仅在一项研究中进行了评估。偏倚风险评估发现所有 9 项研究的方法和报告均存在局限性。
结论:本范围综述确定了 9 项评估虚弱患者药物不良反应的研究。然而,所有研究都受到方法学质量和研究因素报告不足的限制。很少有高质量的研究描述了药物不良反应与衰弱之间的关系。需要更多的稳健研究来检查衰弱与药物不良反应之间的独立关系,同时要调整所有可能的混杂因素,特别是多种药物治疗。
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