Yoshimura Yoshihiro, Matsumoto Ayaka, Momosaki Ryo
Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
Department of Pharmacy, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
Prog Rehabil Med. 2022 May 14;7:20220025. doi: 10.2490/prm.20220025. eCollection 2022.
Pharmacotherapy is important in older patients undergoing rehabilitation because such patients, especially those with frailty and physical disabilities, are susceptible to drug-related functional impairment. Drug-related problems include polypharmacy, potentially inappropriate medications (PIMs), and potential prescription omissions. These problems are associated with adverse drug events such as dysphagia, depression, drowsiness, falls and fractures, incontinence, decreased appetite, and Parkinson's syndrome, leading to impaired improvement in activities of daily living (ADL), quality of life (QOL), and nutritional status. Moreover, the anticholinergic burden is associated with impaired physical and cognitive functions. Therefore, pharmacist-centered multidisciplinary pharmacotherapy should be performed to maximize rehabilitation outcomes. Pharmacotherapy includes a review of all medications, the assessment of drug-related problems, goal setting, correction of polypharmacy and PIMs, monitoring of drug prescriptions, and reassessment of drug-related problems. The goal of pharmacotherapy in rehabilitation medicine is to optimize drug prescribing and to maximize the improvement of ADL and QOL as patient outcomes. The role of pharmacists during rehabilitation is to treat patients as part of multidisciplinary teams and as key members of nutritional support teams. In this review, we aim to highlight existing evidence regarding pharmacotherapy in older adults, including drug-related functional impairment and the association between pharmacotherapy and functional, cognitive, and nutritional outcomes among patients undergoing rehabilitation. In addition, we highlight the important role of pharmacists in maximizing improvements in rehabilitation outcomes and minimizing drug-related adverse effects.
药物治疗对于正在接受康复治疗的老年患者非常重要，因为这类患者，尤其是那些身体虚弱和有身体残疾的患者，容易出现与药物相关的功能损害。与药物相关的问题包括多重用药、潜在不适当用药（PIMs）以及潜在的处方遗漏。这些问题与不良药物事件相关，如吞咽困难、抑郁、嗜睡、跌倒和骨折、尿失禁、食欲下降以及帕金森综合征，导致日常生活活动（ADL）、生活质量（QOL）和营养状况的改善受损。此外，抗胆碱能负担与身体和认知功能受损有关。因此，应以药师为中心进行多学科药物治疗，以最大限度地提高康复效果。药物治疗包括对所有药物进行审查、评估与药物相关的问题、设定目标、纠正多重用药和PIMs、监测药物处方以及重新评估与药物相关的问题。康复医学中药物治疗的目标是优化药物处方，并最大限度地改善ADL和QOL作为患者的治疗结果。药师在康复过程中的作用是将患者作为多学科团队的一部分以及营养支持团队的关键成员进行治疗。在本综述中，我们旨在强调关于老年人药物治疗的现有证据，包括与药物相关的功能损害以及康复患者中药物治疗与功能、认知和营养结果之间的关联。此外，我们强调药师在最大限度地改善康复效果和最小化与药物相关的不良反应方面的重要作用。
