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老年人的营养状况与潜在不适当用药

Nutritional Status and Potentially Inappropriate Medications in Elderly.

作者信息

Loddo Simona, Salis Francesco, Rundeddu Samuele, Serchisu Luca, Peralta Maria Monica, Mandas Antonella

机构信息

Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy.

University Hospital "Azienda Ospedaliero-Universitaria" of Cagliari, SS554 Bivio Sestu, 09042 Monserrato, Italy.

出版信息

J Clin Med. 2022 Jun 16;11(12):3465. doi: 10.3390/jcm11123465.

Abstract

(1) Background: The association between polypharmacy and malnutrition has been investigated in several studies; however, few of these specifically deepened the relationship between potentially inappropriate medication and malnutrition. With a descriptive approach, the primary aim of our study was to evaluate the impact of the nutritional status, assessed with the Mini Nutritional Assessment (MNA), on potentially inappropriate medications (PIM), estimated 10-year survival, and the risk of adverse drug reactions in elderly patients; the secondary aim was to evaluate how the Screening Tool of Older People’s Prescriptions (STOPP), Screening Tool to Alert to Right Treatment (START), and BEERS 2019 criteria identify PIM compared to nutritional status. (2) Methods: In this study, 3091 subjects were enrolled, of whom 2748 (71.7%) were women; the median age was 80 years, with an interquartile range between 75 and 85 years of age. The subjects were assessed at the outpatient service for frail older people of the University Hospital of Cagliari. The study population was evaluated for their: MNA, Charlson Comorbidity Index, 10-year survival estimation, BEERS 2019, STOPP and START criteria, and ADR Risk scores. (3) Results: We divided the study population into three groups: MNA1 (MNA score ≥ 24), MNA2 (23.5−17), and MNA3 (<17): the severity of comorbidities, STOPP and START alerts, and BEERS 2019 criteria were significantly worse in both MNA2 and MNA3 compared to MNA1—with the exception of BEERS “non-anti-infective medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults”. Moreover, the estimated 10-year survival was significantly higher in MNA1 than in MNA2 and MNA3, and also in MNA2 compared to MNA3. Finally, the ADR risk scores were significantly lower in MNA1 than in MNA2 and MNA3. (4) Conclusions: Our study demonstrated the association between nutritional status and PIM checked with the BEERS 2019 criteria, and, for the first time, with the STOPP and START criteria.

摘要

(1) 背景:多项研究对多重用药与营养不良之间的关联进行了调查;然而,其中很少有研究专门深入探讨潜在不适当用药与营养不良之间的关系。本研究采用描述性方法,主要目的是评估用微型营养评定法(MNA)评估的营养状况对老年患者潜在不适当用药(PIM)、估计的10年生存率以及药物不良反应风险的影响;次要目的是评估老年人处方筛查工具(STOPP)、正确治疗警示筛查工具(START)和2019版Beers标准与营养状况相比,如何识别PIM。(2) 方法:本研究纳入3091名受试者,其中2748名(71.7%)为女性;中位年龄为80岁,四分位间距在75至85岁之间。这些受试者在卡利亚里大学医院老年虚弱门诊接受评估。对研究人群进行了以下评估:MNA、查尔森合并症指数、10年生存估计、2019版Beers标准、STOPP和START标准以及药物不良反应风险评分。(3) 结果:我们将研究人群分为三组:MNA1(MNA评分≥24)、MNA2(23.5 - 17)和MNA3(<17):与MNA1相比,MNA2和MNA3的合并症严重程度、STOPP和START警示以及2019版Beers标准均显著更差——2019版Beers标准中“老年人肾功能不同水平时应避免或减少剂量的非抗感染药物”除外。此外,MNA1的估计10年生存率显著高于MNA2和MNA3,MNA2也高于MNA3。最后,MNA1的药物不良反应风险评分显著低于MNA2和MNA3。(4) 结论:我们的研究证明了营养状况与用2019版Beers标准检查的PIM之间的关联,并且首次证明了与STOPP和START标准之间的关联。

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