Center for Appropriate Medication Use, Sheba Medical Center, Tel Hashomer, Israel.
Homecare Hospice Service, Israel Cancer Association, Givatayim, Israel.
Isr Med Assoc J. 2022 Jun;24(6):393-398.
There has been a rapid increase in vulnerable subpopulations of very old with co-morbidity, dementia, frailty, and limited life expectancy. Being treated by many specialists has led to an epidemic of inappropriate medication use and polypharmacy (IMUP) with negative medical and economic consequences. For most medications there are no evidence-based studies in older people and treatments are based on guidelines proven in much younger/healthier populations.
To evaluate whether the benefits of reducing IMUP by poly-de-prescribing (PDP) outweighs the negative outcomes in older people with polypharmacy.
The Garfinkel method and algorithm were used in older people with polypharmacy (≥ 6 prescription drugs).
We found that in nursing departments, of 331 drugs de-prescribed only 32 (10%) had to be re-administered. Annual mortality and severe complications requiring referral to acute care facility were significantly reduced in PDP (P < 0.002). In community dwelling older people, successful de-prescribing was achieved in 81% with no increase in adverse events or deaths. Those who de-prescribed ≥ 3 prescription drugs showed significantly more improvement in functional and cognitive status, sleep quality, appetite, serious complications, quality of life, and general satisfaction compared to controls who stopped ≤ 2 medications (P < 0.002). Rates of hospitalization and mortality were comparable. Clinical improvement by polydeprescribing was usually evident within 3 months and persisted for several years. The main barrier to polydeprescribing was physician's unwillingness to deprescribe (P < 0.0001).
Applying the Garfinkel method of PDP may improve the lives of older people and save money.
患有合并症、痴呆症、虚弱和预期寿命有限的非常高龄脆弱亚群迅速增加。由于许多专科医生对这些患者进行治疗，导致了不适当药物使用和多种药物治疗（IMUP）的流行，从而产生了负面的医疗和经济后果。对于大多数药物，在老年人中没有基于证据的研究，治疗方法基于在更年轻/更健康人群中证明有效的指南。
评估通过多药物减少处方（PDP）减少 IMUP 的益处是否超过了患有多种药物治疗的老年人的负面结果。
使用 Garfinkel 方法和算法对患有多种药物治疗的老年人（≥6 种处方药）进行评估。
我们发现，在护理部门，在减少的 331 种药物中，只有 32 种（10%）需要重新开处方。在 PDP 中，年度死亡率和需要转诊到急性护理机构的严重并发症显著降低（P<0.002）。在社区居住的老年人中，成功减少处方的比例为 81%，且无不良事件或死亡增加。与停止使用≤2 种药物的对照组相比，减少≥3 种处方药的患者在功能和认知状态、睡眠质量、食欲、严重并发症、生活质量和总体满意度方面的改善更为显著（P<0.002）。住院率和死亡率相当。通过多药物减少处方获得的临床改善通常在 3 个月内显现，并持续多年。多药物减少处方的主要障碍是医生不愿意减少处方（P<0.0001）。
应用 PDP 的 Garfinkel 方法可能会改善老年人的生活并节省资金。
