Verma Aparna, Saha Sanjib, Jarl Johan, Conlon Ellen, McGuinness Bernadette, Trépel Dominic
Health Economics Unit, Department of Clinical Science (Malmö), Lund University, SE-22381 Lund, Sweden.
Trinity College Institute for Neuroscience, Trinity College Dublin, D02 PN40 Dublin, Ireland.
J Clin Med. 2023 Feb 9;12(4):1379. doi: 10.3390/jcm12041379.
Frailty refers to the lack of resilience and a reduction in a person's ability to recover following a health problem, and it is increasingly becoming a challenging aspect of ageing populations. Many older adults are exposed to polypharmacy; i.e., they continue to be on medications without timely re-evaluation. Medication reviews have proven successful in managing polypharmacy in the general population, but there is uncertainty regarding their effect among frail older adults. This overview of published systematic reviews assesses the impact of medication reviews on polypharmacy in frail older adults. Embase was searched from its inception to January 2021 and 28 systematic reviews were identified, out of which 10 were included in the overview. Medication reviews were the most common intervention in 8 out of 10 systematic reviews. The frailty score was reported as an outcome in one systematic review that found no evidence for fundamental pharmacological effects on frailty. Six systematic reviews reported a statistically significant reduction in the number of inappropriately prescribed medications. Four systematic reviews reported on hospital admissions, with two of them reporting a decrease in hospitalisations. The quality assessment was moderate in six and critically low in four of the systematic reviews. We conclude that medication reviews help in reducing the use of inappropriate medications in frail older adults, but that there is insufficient evidence in terms of frailty score and hospital admissions.
衰弱是指缺乏恢复力，以及一个人在出现健康问题后恢复能力的下降，并且它日益成为老龄化人口面临的一个具有挑战性的方面。许多老年人面临多重用药的情况；也就是说，他们持续用药却没有及时重新评估。药物审查已被证明在管理普通人群的多重用药方面是成功的，但对于其在衰弱老年人中的效果仍存在不确定性。这篇已发表的系统评价综述评估了药物审查对衰弱老年人多重用药的影响。对Embase从其创建到2021年1月进行了检索，共识别出28篇系统评价，其中10篇被纳入该综述。在10篇系统评价中的8篇里，药物审查是最常见的干预措施。在一篇系统评价中，衰弱评分被报告为一项结果，该评价未发现对衰弱有根本药理学作用的证据。6篇系统评价报告了不适当处方药物数量在统计学上有显著减少。4篇系统评价报告了住院情况，其中2篇报告住院人数有所减少。6篇系统评价的质量评估为中等，4篇的质量评估极低。我们得出结论，药物审查有助于减少衰弱老年人不适当药物的使用，但在衰弱评分和住院情况方面证据不足。
