Dalin Dagmar Abelone, Frandsen Sara, Madsen Gitte Krogh, Vermehren Charlotte
Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg, DK-2400 Copenhagen, Denmark.
General practice "Roskilde Lægehus", Roskilde, DK-4000 Roskilde, Denmark.
Pharmaceuticals (Basel). 2022 Apr 21;15(5):505. doi: 10.3390/ph15050505.
The use of inappropriate medication is an increasing problem among the elderly, leading to hospitalizations, mortality, adverse effects, and lower quality of life (QoL). Deprescribing interventions (e.g., medication reviews (MRs)) have been examined as a possible remedy for this problem. In order to be able to evaluate the potential benefits and harms of a deprescribing intervention, quality of life (QoL) has increasingly been used as an outcome. The sensitivity of QoL measurements may, however, not be sufficient to detect a change in specific disease symptoms, e.g., a flair-up in symptoms or relief of side effects after deprescribing. Using symptom assessments as an outcome, we might be able to identify and evaluate the adverse effects of overmedication and deprescribing alike. The objective of this study was to explore whether symptom assessment is a feasible and valuable method of evaluating outcomes of MRs among the elderly in nursing homes. To the best of our knowledge, this has not been investigated before. We performed a feasibility study based on an experimental design and conducted MRs for elderly patients in nursing homes. Their symptoms were registered at baseline and at a follow-up 3 months after performing the MR. In total, 86 patients, corresponding to 68% of the included patients, received the MR and completed the symptom questionnaires as well as the QoL measurements at baseline and follow-up, respectively. Forty-eight of these patients had at least one deprescribing recommendation implemented. Overall, a tendency towards the improvement of most symptoms was seen after deprescribing, which correlated with the tendencies observed for the QoL measurements. Remarkably, deprescribing did not cause a deterioration of symptoms or QoL, which might otherwise be expected for patients of this age group, of whom the health is often rapidly declining. In conclusion, it was found that symptom assessments were feasible among nursing home residents and resulted in additional relevant information about the potential benefits and harms of deprescribing. It is thus recommended to further explore the use of symptom assessment as an outcome of deprescribing interventions, e.g., in a controlled trial.
不适当用药在老年人中是一个日益严重的问题，会导致住院、死亡、不良反应以及生活质量（QoL）下降。减药干预措施（如药物审查（MRs））已被视为解决这一问题的可能方法。为了能够评估减药干预的潜在益处和危害，生活质量（QoL）越来越多地被用作一项指标。然而，QoL测量的敏感性可能不足以检测特定疾病症状的变化，例如减药后症状的突然发作或副作用的缓解。将症状评估作为一项指标，我们或许能够识别和评估过度用药及减药的不良反应。本研究的目的是探讨症状评估是否是评估养老院老年人药物审查结果的一种可行且有价值的方法。据我们所知，此前尚未对此进行过研究。我们基于实验设计进行了一项可行性研究，并对养老院的老年患者进行了药物审查。在基线时以及进行药物审查3个月后的随访中记录他们的症状。总共86名患者，占纳入患者的68%，接受了药物审查，并分别在基线和随访时完成了症状问卷以及生活质量测量。其中48名患者至少实施了一项减药建议。总体而言，减药后大多数症状有改善的趋势，这与生活质量测量中观察到的趋势相关。值得注意的是，减药并未导致症状或生活质量恶化，而对于这个年龄组的患者，原本可能会预期出现这种情况，因为他们的健康状况往往迅速下降。总之，研究发现症状评估在养老院居民中是可行的，并能提供有关减药潜在益处和危害的额外相关信息。因此，建议进一步探索将症状评估用作减药干预措施的一项指标，例如在一项对照试验中。
