老年人和照护者对法语国家药物减量的态度和信念:一项多中心横断面研究。

Attitudes and beliefs of older adults and caregivers towards deprescribing in French-speaking countries: a multicenter cross-sectional study.

机构信息

Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology-Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France.

Faculty of Medicine, Laval University, Quebec, Canada.

出版信息

Eur J Clin Pharmacol. 2022 Oct;78(10):1633-1646. doi: 10.1007/s00228-022-03368-1. Epub 2022 Jul 27.

Abstract

PURPOSE

Successful deprescribing requires understanding the attitudes of older adults and caregivers towards this process. This study aimed to capture these attitudes in four French-speaking countries and to investigate associated factors.

METHODS

A multicenter cross-sectional study was conducted by administrating the French version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Belgium, Canada, France, and Switzerland. Community-dwelling or nursing home older adults ≥ 65 years taking ≥ 1 prescribed medications and caregivers of older adults with similar characteristics were included. Multivariate logistic regressions were carried out to examine factors associated with willingness to deprescribe.

RESULTS

A total of 367 older adults (79.3 ± 8.7 years, 63% community-dwelling, 54% ≥ 5 medications) and 255 unrelated caregivers (64.4 ± 12.6 years) of care recipients (83.4 ± 7.9 years, 52% community-dwelling, 69% ≥ 5 medications) answered the questionnaire. Among them, 87.5% older adults and 75.6% caregivers would be willing to stop medications if the physician said it was possible. Reluctance to stop a medication taken for a long time was expressed by 46% of both older adults and caregivers. A low score for the factor "concerns about stopping" (older adults: aOR: 0.21; 95% CI: 0.07-0.59), and a high score for the factor "involvement" (older adults: aOR: 2.66; 95% CI: 1.01-7.07; caregivers: aOR: 11.28; 95% CI: 1.48-85.91) were associated with willingness to deprescribe.

CONCLUSIONS

A significant proportion of older adults and caregivers of French-speaking countries are open to deprescribing. Despite this apparent willingness, deprescribing conversations in clinical practice remains marginal, emphasizing the importance of optimizing the integration of existing tools such as rPATD.

摘要

目的

成功减药需要了解老年人和照护者对这一过程的态度。本研究旨在四个法语国家捕捉这些态度,并调查相关因素。

方法

通过在比利时、加拿大、法国和瑞士开展法语版修订患者减药态度问卷(rPATD)多中心横断面研究,纳入社区居住或居住在养老院≥65 岁服用≥1 种处方药物的老年人和具有相似特征的老年人照护者。采用多变量逻辑回归分析考察与减药意愿相关的因素。

结果

共纳入 367 名老年人(79.3±8.7 岁,63%社区居住,54%≥5 种药物)和 255 名无亲属关系的照护者(64.4±12.6 岁)的照护者(83.4±7.9 岁,52%社区居住,69%≥5 种药物)回答了问卷。其中,87.5%的老年人和 75.6%的照护者表示如果医生说可能,他们愿意停止用药。46%的老年人和照护者均表示不愿停止长期服用的药物。“停止用药的顾虑”得分较低(老年人:aOR:0.21;95%CI:0.07-0.59),“参与”得分较高(老年人:aOR:2.66;95%CI:1.01-7.07;照护者:aOR:11.28;95%CI:1.48-85.91)与减药意愿相关。

结论

法语国家有相当一部分老年人和照护者愿意减药。尽管有这种明显的意愿,但在临床实践中减药对话仍然很少,这强调了优化整合现有工具(如 rPATD)的重要性。

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