College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea.
Medicine (Baltimore). 2022 Dec 9;101(49):e31739. doi: 10.1097/MD.0000000000031739.
As the population of the elderly in long-term care facilities has grown, the number of users of potentially inappropriate medication (PIM) is also increasing. With this study, we aimed to investigate the pattern of PIM usage and related factors among the elderly receiving long-term care services. Using the South Korean National Health Insurance Service Elderly Cohort Database, we conducted a retrospective matched cohort study. Elderly residents (n = 1980) in long-term care facilities in 2013 were selected and matched 1:1 with elderly persons living in the community applying propensity score method. The matching variables were sex, age, health insurance type, long-term care grade, Charlson's Comorbidity Index score, presence of dementia, cerebrovascular disease, or Parkinson's disease, and number of drugs prescribed. PIM use was assessed according to Beers criteria 2019. The prevalence of PIM was found to be higher among the elderly in long-term care facilities (86.77%) than among community-dwelling individuals (75.35%). Logistic regression showed that long-term care facility residents were 1.84 odds more likely to use PIM than community-dwelling older adults. We also confirmed that the average number of medications taken per day and the number of outpatient visits were the major influencing factors affecting PIM prescriptions. In addition, elders living in long-term care facilities were prescribed more PIM drugs acting on the central nervous system than community-dwelling older adults. The results of this study show that among those receiving long-term care services, older people in long-term care facilities use PIM more than do the elderly living at home. Medication management programs need to be developed to reduce the use of PIM in long-term care facilities.
随着长期护理机构中老年人人口的增长，潜在不适当用药（PIM）的使用者数量也在增加。本研究旨在调查长期护理服务使用者中 PIM 的使用模式和相关因素。我们使用韩国国家健康保险服务老年人队列数据库，进行了回顾性匹配队列研究。2013 年，我们选择了长期护理机构中的老年居民（n=1980），并使用倾向评分匹配法与居住在社区中的老年人进行 1:1 匹配。匹配变量包括性别、年龄、医疗保险类型、长期护理等级、Charlson 合并症指数评分、痴呆、脑血管病或帕金森病的存在以及开具的药物数量。根据 Beers 标准 2019 评估 PIM 的使用情况。结果发现，长期护理机构中的老年人（86.77%）比居住在社区中的老年人（75.35%）更有可能使用 PIM。Logistic 回归显示，长期护理机构的居民使用 PIM 的可能性是居住在社区的老年人的 1.84 倍。我们还证实，每天服用的药物平均数量和门诊就诊次数是影响 PIM 处方的主要因素。此外，居住在长期护理机构的老年人比居住在社区的老年人开具更多作用于中枢神经系统的 PIM 药物。本研究结果表明，在接受长期护理服务的人群中，长期护理机构中的老年人比居住在家庭中的老年人更常使用 PIM。需要制定药物管理计划，以减少长期护理机构中 PIM 的使用。
