认知障碍患者在日间护理中心跌倒和住院的预测因素：多病共存、多种药物治疗和潜在不适当药物的作用。

Predictors of falls and hospital admissions in people with cognitive impairment in day-care: role of multimorbidity, polypharmacy, and potentially inappropriate medication.

机构信息

Department of Psychiatry and Psychotherapy, Center for Health Services Research in Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.

出版信息

BMC Geriatr. 2022 Aug 18;22(1):682. doi: 10.1186/s12877-022-03346-3.

DOI:10.1186/s12877-022-03346-3

PMID:35982409

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9387045/

Abstract

BACKGROUND

Multimorbidity, polypharmacy, and potentially inappropriate medication (PIM) pose challenges for the care of people with cognitive impairment. The aim of the present study is to explore whether multimorbidity, polypharmacy, and PIM predict falls and hospital admissions in a sample of people with cognitive impairment in day-care centers in Germany.

METHODS

We used data from the German day-care study (multicenter longitudinal study, n = 433). Multimorbidity was defined as ≥ 2 chronic diseases. Polypharmacy was defined as prescriptions to ≥ 5 drugs. Potentially inappropriate medication was defined as scoring on the PRISCUS list. Binary logistic regression analyses were computed to determine whether multimorbidity, polypharmacy, and potentially inappropriate medication at t0 predicted falls and hospital admissions as outcomes at t1 (six months later).

RESULTS

The rate of multimorbidity and polypharmacy was 87.8% and 60.3%, respectively. 15.9% of the people with cognitive impairment received PIM / PRISCUS-listed drugs, 43.6% ACB-listed drugs, and 52.7% CNS depressant drugs. Falls and hospital admissions during follow-up were prevalent in 19.4% and 24.7% of the people with cognitive impairment. Both were significantly predicted by the total number of drugs (falls: OR = 1.152, p = 0.001, overall model: p < 0.001; hospital admissions: OR = 1.103, p = 0.020, overall model: p = 0.001), even if regression analyses were controlled for the number of comorbidities.

CONCLUSIONS

Polypharmacy and potentially inappropriate medication are highly prevalent in people with cognitive impairment in German day-care centers. The number of drugs and appropriateness of medication seem to be crucial for the risk of falls and hospital admissions. Polypharmacy and PIM should be critically reviewed by healthcare providers and avoided as much as and whenever possible.

TRIAL REGISTRATION

ISRCTN16412551, 30 July 2014, registered partly retrospectively.

摘要

背景

多种疾病、多种药物治疗和潜在不适当药物（PIM）给认知障碍患者的护理带来了挑战。本研究的目的是探讨在德国日间护理中心的认知障碍患者样本中，多种疾病、多种药物治疗和 PIM 是否会预测跌倒和住院。

方法

我们使用了德国日间护理研究（多中心纵向研究，n=433）的数据。多种疾病定义为≥2 种慢性疾病。多种药物治疗定义为开具≥5 种药物。潜在不适当药物定义为 PRISCUS 列表上的评分。使用二元逻辑回归分析确定 t0 时的多种疾病、多种药物治疗和潜在不适当药物是否预测 t1（6 个月后）时的跌倒和住院。

结果

多种疾病和多种药物治疗的发生率分别为 87.8%和 60.3%。15.9%的认知障碍患者接受了 PIM/PRISCUS 列表药物、43.6%的 ACB 列表药物和 52.7%的 CNS 抑制剂药物。随访期间，19.4%的认知障碍患者发生跌倒，24.7%的认知障碍患者发生住院。在控制了共病数量后，这些结果在总体模型中均具有统计学意义（跌倒：OR=1.152，p=0.001；总体模型：p<0.001；住院：OR=1.103，p=0.020；总体模型：p=0.001）。