为老年患者进行减药干预：一项系统评价和荟萃分析。
Deprescribing Interventions for Older Patients: A Systematic Review and Meta-Analysis.
机构信息
Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China; Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
出版信息
J Am Med Dir Assoc. 2023 Nov;24(11):1718-1725. doi: 10.1016/j.jamda.2023.07.016. Epub 2023 Aug 12.
OBJECTIVES
Deprescribing reduces polypharmacy in older adults. A thorough study of the effect of deprescribing interventions on clinical outcomes in older adults is presently lacking. As a result, we evaluated the impact of deprescribing on clinical outcomes in older patients.
DESIGN
Meta-analysis and systematic review of randomized controlled trials (RCTs). PubMed, EMBASE, and Cochrane Library were searched from the time of creation to March 2023.
SETTING AND PARTICIPANTS
Randomized controlled trial with participants at least 60 years old.
MEASURES
Mortality, falls (number of fallers), hospitalization rates, emergency department visits, medication adherence, HRQoL (health-regulated quality of life), incidence of ADR (adverse drug reactions), PIM (potentially inappropriate medication), and PPO (potentially prescription omission) were evaluated in the meta-analysis.
RESULTS
A total of 32 RCTs (18,670 patients) were included. Deprescribing interventions significantly reduced proportions of older adults with PIM, PPO, and the incidence of ADRs. The interventions group also improved medication compliance.
CONCLUSIONS AND IMPLICATIONS
Compared to routine care, deprescribing interventions significantly improve clinical outcome indicators for older adults.
目的
减少老年人的多重用药。目前缺乏对减少药物干预对老年人临床结局影响的全面研究。因此，我们评估了减少药物对老年患者临床结局的影响。
设计
随机对照试验的荟萃分析和系统评价。从创建到 2023 年 3 月，在 PubMed、EMBASE 和 Cochrane Library 中进行了检索。
设置和参与者
至少 60 岁的参与者的随机对照试验。
测量
死亡率、跌倒（跌倒人数）、住院率、急诊就诊率、药物依从性、HRQoL（健康调节生活质量）、ADR（药物不良反应）发生率、PIM（潜在不适当药物）和 PPO（潜在处方遗漏）在荟萃分析中进行了评估。
结果
共纳入 32 项 RCT（18670 名患者）。减少药物干预显著降低了具有 PIM、PPO 和 ADR 发生率的老年人比例。干预组还提高了药物依从性。
结论和意义
与常规护理相比，减少药物干预显著改善了老年人的临床结局指标。
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