García Cristina, Ocaña José M, Alacreu Mónica, Moreno Lucrecia, Martínez Luis A
Community Pharmacy, 02161 Albacete, Spain.
Cátedra DeCo MICOF-CEU UCH, University Cardenal Herrera-CEU, 46115 Valencia, Spain.
J Clin Med. 2024 Sep 27;13(19):5755. doi: 10.3390/jcm13195755.
Frailty and polymedication are closely interrelated. Addressing these concurrent conditions in primary care settings relies on the utilization of potentially inappropriate medication (PIM) lists and medication reviews (MRs), particularly in rural areas, where healthcare professionals serve as the sole point of access to the medical system. The aim of this study was to examine the relationship between medication appropriateness and variables related to frailty in a rural municipality in order to propose potential strategies for therapy optimization. : This cross-sectional study included all adult community dwellers aged 50 and above officially registered in the municipality of Tiriez (Albacete, Spain) in 2023 ( = 241). The primary outcome variable was frailty (assessed using the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale). The independent variables were age, gender, medication regimen, history of falls, comorbidities, PIMs (evaluated using the screening tool of older persons' prescriptions (STOPP) 2023 criteria), fall-risk-increasing drugs (FRID), and anticholinergic burden (ACB). : The prevalence of frailty was approximately 20%. FRID and ACB scores were statistically associated (-value < 0.001) with frailty, 1.1 ± 1.3 vs. 2.5 ± 1.7, and 1.0 ± 1.3 vs. 2.8 ± 2.5, respectively. Regardless of age, frailty was observed to be more prevalent among females (odds ratio (OR) [95% confidence interval (CI)]: 3.5 [1.5, 9.0]). On average, 2.1 ± 1.6 STOPP criteria were fulfilled, with the prolonged use of anxiolytics and anti-peptic-ulcer agents being the most frequent. Priority interventions (PIs) included opioid dose reduction, benzodiazepine withdrawal, and the assessment of antidepressant and antiplatelet treatment plans. The optimization of medication in primary care is of paramount importance for frail patients. Interventional measures should focus on ensuring the correct dosage and combination of drugs for each therapeutic regimen.
衰弱与多重用药密切相关。在基层医疗环境中应对这些并发情况依赖于使用潜在不适当用药（PIM）清单和药物审查（MR），尤其是在农村地区，那里的医疗保健专业人员是医疗系统的唯一接入点。本研究的目的是调查一个农村市镇中药物适宜性与衰弱相关变量之间的关系，以便提出治疗优化的潜在策略。：这项横断面研究纳入了2023年在蒂列斯镇（西班牙阿尔瓦塞特）正式登记的所有50岁及以上的成年社区居民（n = 241）。主要结局变量是衰弱（使用疲劳、抵抗力、行走能力、疾病和体重减轻（FRAIL）量表进行评估）。自变量包括年龄、性别、用药方案、跌倒史、合并症、PIM（使用老年人处方筛查工具（STOPP）2023标准进行评估）、增加跌倒风险的药物（FRID）和抗胆碱能负担（ACB）。：衰弱的患病率约为20%。FRID和ACB评分与衰弱在统计学上相关（p值<0.001），分别为1.1±1.3与2.5±1.7，以及1.0±1.3与2.8±2.5。无论年龄如何，女性中衰弱更为普遍（优势比（OR）[95%置信区间（CI）]：3.5[1.5，9.0]）。平均满足2.1±1.6条STOPP标准，最常见的是长期使用抗焦虑药和抗消化性溃疡药。优先干预措施（PI）包括减少阿片类药物剂量、停用苯二氮䓬类药物以及评估抗抑郁药和抗血小板治疗方案。基层医疗中药物的优化对衰弱患者至关重要。干预措施应侧重于确保每种治疗方案的药物剂量正确且组合合理。
