Braun School of Public Health, The Hebrew University of Jerusalem, 9112001, Jerusalem, Israel.
Israel Center for Disease Control, Israel Ministry of Health, 5262100, Ramat Gan, Israel.
BMC Geriatr. 2022 Jun 13;22(1):502. doi: 10.1186/s12877-022-03171-8.
Polypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years.
Demographic and health data from two representative national health cross-sectional surveys - MABAT ZAHAV 1 (MZ1) in 2005-2006, and MZ2 in 2014-2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI).
Self-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drugs were for hypertension (27.0%, 25.3%), dyslipidemia (9.7%, 12.4%) and anticoagulation (9.2%, 9.8%). For approximately 10% of drugs, indications were either unknown or incorrect. Polypharmacy was significantly associated with poor self-health assessment 2.47 (1.99, 3.06), ≥ 4 versus 1-3 chronic illnesses 6.36 (3.85, 10.50), and age ≥ 80 versus younger 1.72 (1.32, 2.24). Similar associations were observed with major polypharmacy of ≥ 8 medications.
Polypharmacy, although reduced in the last decade, requires constant attention, especially concerning lack of knowledge of indications which leads to poor adherence and adverse side effects. Health-care teams should carry out regular medicine reconciliation in at-risk elderly patients.
随着年龄的增长，多种药物治疗的使用会增加，并与严重的健康和经济成本相关。本研究报告了在以色列社区居住的年龄≥65 岁的老年人中，十年来药物使用模式和多种药物治疗的变化。
对两项具有代表性的全国健康横断面调查——MABAT ZAHAV 1（MZ1）（2005-2006 年）和 MZ2（2014-2015 年）的人口统计学和健康数据进行分析。多种药物治疗定义为使用≥5 种药物。使用多变量逻辑回归估计多种药物治疗的风险因素，并使用调整后的优势比（aOR）及其 95%置信区间（CI）进行估计。
在 MZ1 中有 1647 名参与者（91.5%）和 MZ2 中有 833 名参与者（80.2%）报告了他们服用的药物，女性占 55%，大约 20%的参与者年龄≥80 岁，这两项调查均如此。MZ2 中的多种药物治疗的患病率明显低于 MZ1：64.2%比 56.3%，p=0.0001；aOR（95%CI）为 0.64（0.52，0.80）。最常服用的药物是治疗高血压（27.0%，25.3%）、血脂异常（9.7%，12.4%）和抗凝治疗（9.2%，9.8%）。大约 10%的药物的适应证或不明确或不正确。多种药物治疗与自我健康评估差（2.47 [1.99，3.06]）、慢性疾病≥4 种与 1-3 种（6.36 [3.85，10.50]）、年龄≥80 岁与年龄较轻（1.72 [1.32，2.24]）显著相关。类似的关联也见于≥8 种药物的主要多种药物治疗。
尽管过去十年中多种药物治疗的使用有所减少，但仍需要持续关注，尤其是需要关注缺乏对药物适应证的了解，这会导致治疗依从性差和不良反应。医疗保健团队应在高危老年患者中定期进行药物调整。
