美国老年人潜在不适当药物处方与健康相关生活质量的关系。
Association between potentially inappropriate medications prescription and health-related quality of life among US older adults.
机构信息
Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA.
Department of Pharmacy, State University of New York Upstate Medical University, Syracuse, New York, USA.
出版信息
J Am Geriatr Soc. 2024 Sep;72(9):2807-2815. doi: 10.1111/jgs.18957. Epub 2024 May 10.
BACKGROUND
Potentially inappropriate medications (PIMs) are associated with worse health outcomes among older adults. Our objective was to examine the association between PIM prescription and health-related quality of life (HRQoL) among older adults in the United States using nationally representative data.
METHODS
This was a retrospective study utilizing 2011-2015 Medical Expenditure Panel Survey (MEPS) data. Community dwelling US adults aged 65 years or older were included. A qualified definition operationalized from the 2019 American Geriatrics Society Beers Criteria® was used to define exposure to PIMs during the study period. The Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) were used to measure HRQoL. Survey-weighted linear regression models were constructed to investigate the association between PIM exposure and participants' PCS and MCS scores. Analyses were stratified across three age cohorts (65-74, 75-85, and ≥85 years).
RESULTS
Unadjusted analysis showed poorer scores in the PIM exposed group for both PCS and MCS (all p < 0.001). PIM exposure was associated with poorer PCS scores across all age groups with those aged 65-74 years (adjusted regression coefficient = -1.60 [95% CI = -2.27, -0.93; p < 0.001]), those 75-84 years (adjusted regression coefficient: -1.49 [95% CI = -2.45, -0.53; p = 0.003]), and those 85 years and older (adjusted regression coefficient = -1.65 [95% CI = -3.03, -0.27; p = 0.02]). PIM exposure was also associated with poorer MCS scores in participants aged 65-74 years (adjusted regression coefficient = -0.69 [95% CI = -1.16, -0.22; p = 0.004]) and 85 years and older (adjusted regression coefficient = -2.01 [95% CI = -3.25, -0.78; p = 0.002]).
CONCLUSIONS
Our results suggest that patients' exposure to PIMs is associated with poorer HRQoL. Further work is needed to assess whether interventions to deprescribe PIMs may help to improve patients' HRQoL.
背景
潜在不适当药物（PIMs）与老年人的健康结果较差有关。我们的目的是使用全国代表性数据，研究美国老年人中 PIM 处方与健康相关生活质量（HRQoL）之间的关联。
方法
这是一项利用 2011-2015 年医疗支出调查（MEPS）数据的回顾性研究。纳入年龄在 65 岁或以上的社区居住的美国成年人。使用 2019 年美国老年医学会 Beers 标准® 的合格定义来定义研究期间 PIM 的暴露情况。使用医疗结果研究 12 项简短健康调查（SF-12）的身体成分摘要（PCS）和心理成分摘要（MCS）来衡量 HRQoL。构建了调查加权线性回归模型，以研究 PIM 暴露与参与者的 PCS 和 MCS 评分之间的关系。分析按三个年龄组（65-74 岁、75-85 岁和≥85 岁）进行分层。
结果
未调整分析显示，在 PCS 和 MCS 方面，暴露于 PIM 的组得分较差（均 p<0.001）。在所有年龄组中，PIM 暴露与 PCS 评分较差相关，65-74 岁年龄组（调整后回归系数=−1.60[95%CI=−2.27，−0.93;p<0.001]），75-84 岁年龄组（调整后回归系数：−1.49[95%CI=−2.45，−0.53;p=0.003]）和 85 岁及以上年龄组（调整后回归系数=−1.65[95%CI=−3.03，−0.27;p=0.02]）。PIM 暴露也与 65-74 岁年龄组参与者的 MCS 评分较差相关（调整后回归系数=−0.69[95%CI=−1.16，−0.22;p=0.004]）和 85 岁及以上年龄组（调整后回归系数=−2.01[95%CI=−3.25，−0.78;p=0.002]）。
结论
我们的结果表明，患者暴露于 PIMs 与较差的 HRQoL 相关。需要进一步评估减少 PIM 的干预措施是否有助于提高患者的 HRQoL。
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