Ude-Okeleke Rosetta Chinyere, Aslanpour Zoe, Dhillon Soraya, Berry Rachel, Bines Emma, Umaru Nkiruka
School of Life and Medical Sciences, University of Hertfordshire, UK.
Cambridge University Hospital NHS Foundation Trust, Pharmacy Department, UK.
Explor Res Clin Soc Pharm. 2023 Dec 16;13:100402. doi: 10.1016/j.rcsop.2023.100402. eCollection 2024 Mar.
Medicines related problems (MRPs) can be common in frail older people due to age-compromised body systems and a propensity to be on multiple drugs concurrently. This group of people can also succumb to a rapid deterioration in health. Thus, it is important to investigate MRPs in frail older people. The objectives of the study were to evaluate prevalence of MRPs, types of MRPs, risk factors and deterioration that can be associated with MRPs in frail older people admitted to an English teaching hospital from primary care.
Included in the sample were frail older adults, aged 65 years and over, admitted from primary care. Data was retrieved from the hospital's electronic patient record system, anonymised, and reviewed for MRPs. MRPs which were retrospectively identified at admission were coded with the WHO-ICD10,2016 (World Health Organisation-International Classification of Diseases version 10, 2016). Descriptive and inferential statistics were performed on the data using SPSS Version 25. Primary outcome was the prevalence of MRPs in frail older patients. Secondary outcome was the association of deterioration indicated as fall, delirium, or NEWs ≥3 with presence of MRPs.
Among the 507 frail older people (≥4 on Rockwood scale) that met criteria for inclusion, 262 (51.8%) were patients with MRPs and 244 (48.2%) without. The Median age of sample as a whole was 85 years ( . Prevalence of MRPs was 33.28%. Types of MRPs were adverse drug reaction (ADR-20%), non-compliance (9.1%), unintentional poisoning (3.3%) and inappropriate polypharmacy (0.8%). In logistic regression, potentially inappropriate medicines (PIM), social support, number of comorbidities and winter were significant predictors of MRPs. Risk of deteriorating with delirium was two times higher in patients with MRPs than in patients without MRPs, RR 2.613 (95% CI, 1.049 to 6.510).
MRPs and risks of deterioration associated with MRPs in frail older people can be reduced. This is because factors associated with MRPs can be modified.
由于身体机能随年龄下降以及倾向于同时服用多种药物，药物相关问题（MRP）在体弱的老年人中可能很常见。这群人也可能会出现健康状况迅速恶化的情况。因此，研究体弱老年人中的MRP很重要。本研究的目的是评估MRP的患病率、MRP的类型、危险因素以及与从初级保健机构转入一家英语教学医院的体弱老年人中MRP相关的健康恶化情况。
纳入样本的是从初级保健机构转入的65岁及以上的体弱老年人。数据从医院的电子病历系统中检索出来，进行匿名化处理，并对MRP进行审查。入院时回顾性确定的MRP用WHO-ICD10,2016（世界卫生组织 - 国际疾病分类第10版，2016年）进行编码。使用SPSS 25版对数据进行描述性和推断性统计。主要结局是体弱老年患者中MRP的患病率。次要结局是跌倒、谵妄或NEWs≥3所表明的健康恶化与MRP存在之间的关联。
在符合纳入标准的507名体弱老年人（Rockwood量表评分≥4）中，262名（51.8%）患有MRP，244名（48.2%）未患。整个样本的中位年龄为85岁（......）。MRP的患病率为33.28%。MRP的类型包括药物不良反应（ADR - 20%）、不依从（9.1%）、意外中毒（3.3%）和不适当的多重用药（0.8%）。在逻辑回归中，潜在不适当用药（PIM）、社会支持、合并症数量和冬季是MRP的显著预测因素。患有MRP的患者出现谵妄导致健康恶化的风险是未患MRP患者的两倍，RR为2.613（95%CI，1.049至6.510）。
体弱老年人中MRP以及与MRP相关的健康恶化风险是可以降低的。这是因为与MRP相关的因素是可以改变的。
