Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, The Czech Republic.
Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, The Czech Republic.
Ann Med. 2024 Dec;56(1):2357232. doi: 10.1080/07853890.2024.2357232. Epub 2024 Jun 4.
Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia.
Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented.
The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8).
Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.
先前的研究引起了人们对养老院（NH）中药物相关问题、多种药物治疗和不适当苯二氮䓬类药物处方的高患病率的关注，并证实缺乏来自中欧和东南欧的研究。我们研究的目的是确定克罗地亚 NH 居民中多种药物治疗、高多种药物治疗和不适当苯二氮䓬类药物处方的流行率和特征。
使用 InterRAI 长期护理设施评估表收集了来自克罗地亚五个 NH 的 226 名老年 NH 居民的数据。记录了多种药物治疗/高多种药物治疗和不适当苯二氮䓬类药物处方模式的流行率和决定因素。
NH 居民中多种药物治疗（49.6%）和高多种药物治疗（25.7%）的患病率很高。在我们的研究中，72.1%的 NH 居民至少开了一种精神药物，36.7%的人使用 2-3 种精神药物，6.6%的人使用 4+种精神药物。在使用苯二氮䓬类药物的患者中（55.8%），28%的居民开了高于推荐的老年剂量的苯二氮䓬类药物，75%的人长期使用，48%的人开了同时使用的相互作用药物。患有多种疾病（6 种以上疾病，比例优势比（POR）=19.8）、2 型糖尿病（POR=5.2）、缺血性心脏病（POR=4.6）、更高的虚弱程度（临床虚弱量表（CFS≥5）；POR=4.3）和胃肠道问题（POR=4.8）的患者开多种药物治疗/高多种药物治疗的可能性明显更高。
尽管存在现有证据和专业运动，但我们的研究强调了 NH 老年居民中药物使用不当和与药物相关的危害仍然是一个持续存在的挑战。有效的监管和政策干预措施，包括老年医学家和临床药师服务的实施，对于解决这一关键问题和确保脆弱的 NH 人群的最佳药物管理至关重要。
