Pharmacy Department, Cliniques Universitaires Saint Luc, Brussels, Belgium.
Clinical Pharmacy Research Group-Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.
Int J Clin Pharm. 2024 Jun;46(3):656-664. doi: 10.1007/s11096-024-01700-6. Epub 2024 Feb 17.
Limited data are available on characteristics associated with antipsychotic use in multimorbid older adults.
Primary: to identify patient characteristics associated with antipsychotic prescribing in a multimorbid population of older inpatients with polypharmacy. Secondary: (1) to observe if antipsychotics use during an index hospitalisation was associated with a drug related admission (DRA) within one year, and (2) to describe these cases of antipsychotic-related readmissions.
This was a secondary analysis of the OPERAM randomized controlled trial. Multivariate analysis assessed the association between characteristics and comorbidities with antipsychotic use. An expert team assessed DRA occurring during the one-year follow-up.
Antipsychotics were prescribed to 5.5% (n = 110) patients upon admission while 7.7% (n = 154) inpatients received antipsychotics at any time (i.e. upon admission, during hospitalisation, and/or at discharge). The most frequently prescribed antipsychotics were quetiapine (n = 152), haloperidol (n = 48) and risperidone (n = 22). Antipsychotic prescribing was associated with dementia (OR = 3.7 95%CI[2.2;6.2]), psychosis (OR = 26.2 [7.4;92.8]), delirium (OR = 6.4 [3.8;10.8]), mood disorders (OR = 2.6 [1.6;4.1]), ≥ 15 drugs a day (OR = 1.7 [1.1;2.6]), functional dependency (Activities of Daily Living score < 50/100) (OR = 3.9 [2.5;6.1]) and < 2 units of alcohol per week (OR = 2.2 [1.4;3.6]). DRA occurred in 458 patients (22.8%) within one year. Antipsychotic prescribing at any time was not associated with DRA (OR = 1.0 [0.3;3.9]) however contributed to 8 DRAs, including 3 falls.
In this European multimorbid polymedicated older inpatients, antipsychotics were infrequently prescribed, most often at low dosage. Besides neuro-psychiatric symptoms, risk factors for inhospital antipsychotic prescribing were lower functional status and polymedication.
关于抗精神病药物在多病老年患者中的使用特点，相关数据有限。
主要目的：确定与多病老年住院患者多药治疗相关的抗精神病药物处方特征。次要目的：（1）观察索引住院期间使用抗精神病药物是否与一年内药物相关入院（DRA）相关；（2）描述这些抗精神病药相关再入院的情况。
这是一项针对 OPERAM 随机对照试验的二次分析。多变量分析评估了特征和合并症与抗精神病药物使用之间的关联。一个专家小组评估了一年内随访期间发生的 DRA。
入院时，5.5%（n=110）的患者开具了抗精神病药物，而 7.7%（n=154）的住院患者在任何时间（即入院时、住院期间和/或出院时）接受了抗精神病药物治疗。最常开的抗精神病药物是喹硫平（n=152）、氟哌啶醇（n=48）和利培酮（n=22）。抗精神病药物的使用与痴呆（OR=3.7，95%CI[2.2;6.2]）、精神病（OR=26.2[7.4;92.8]）、谵妄（OR=6.4[3.8;10.8]）、情绪障碍（OR=2.6[1.6;4.1]）、每天服用≥15 种药物（OR=1.7[1.1;2.6]）、功能依赖（日常生活活动评分<50/100）（OR=3.9[2.5;6.1]）和每周饮酒量<2 单位（OR=2.2[1.4;3.6]）有关。一年内，458 名患者（22.8%）发生 DRA。任何时候使用抗精神病药物与 DRA 无关（OR=1.0[0.3;3.9]），但与 8 例 DRA 相关，其中包括 3 例跌倒。
在这项欧洲多病、多药治疗的老年住院患者中，抗精神病药物的使用频率较低，通常剂量较低。除了神经精神症状外，住院期间抗精神病药物处方的危险因素还包括功能状态较低和多药治疗。
