Novais Teddy, Garnier-Crussard Antoine, Reallon Elsa, Mouchoux Christelle, Gervais Frederic
Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, Lyon, France.
Department of Pharmacy, Charpennes Hospital, Hospices Civils de Lyon, Villeurbanne, France.
J Am Geriatr Soc. 2025 May;73(5):1542-1550. doi: 10.1111/jgs.19324. Epub 2025 Jan 3.
In older people, medications with anticholinergic or sedative properties are associated with falls, frailty, and functional and cognitive impairment. These medications are often described as a subset of potentially inappropriate medications (PIMs). We examined the prevalence of anticholinergic or sedative medications to avoid in older people in France in 2023.
This cross-sectional study used anonymized data from a large electronic healthcare database, the French National Health Data System (Système National des Données de Santé, SNDS). All people aged 65 years or older from January 1, 2023, to December 31, 2023, were included in this study. Dispensations of anticholinergic and sedative medications were identified according to PIM criteria (2023 American Geriatrics Society Beers Criteria and REMEDI[e]S tool). The prevalence of anticholinergic or sedative medications was assessed for the study population and by age (65-84 and 85 or older) and living place (home and institutionalized patients) subgroups in terms of number and percentage of patients.
This study included 16,938,152 patients aged 65 years or older (55% women). Among all patients, 79.8% were aged between 65 and 84 years and 20.2% were aged 85 years or older. Most patients lived at home (97.0%), and 3.0% were institutionalized. The prevalence of anticholinergic or sedative medications was 32.8% among all patients, 32.3% among 65-84 patients, and 34.8% among 85 or older patients, 32.1% among home patients, and 54.5% among institutionalized patients. The most commonly dispensed anticholinergic or sedative medications were oxazepam (5.27%), alprazolam (5.27%), zopiclone (4.85%), bromazepam (4.23%), metopimazine (2.88%), paroxetine (2.70%), nefopam (2.57%), and hydroxyzine (2.17%).
This study highlighted that anticholinergic and sedative medications to avoid in older people are still frequently prescribed despite the development and regular updating of PIM criteria. Future studies are needed to assess whether this has led to worsened outcomes among older adults who utilized these medications, and new initiatives should be developed to further promote deprescribing by prescribers and pharmacists.
在老年人中，具有抗胆碱能或镇静特性的药物与跌倒、虚弱以及功能和认知障碍有关。这些药物通常被描述为潜在不适当药物（PIMs）的一个子集。我们研究了2023年法国老年人中应避免使用的抗胆碱能或镇静药物的流行情况。
这项横断面研究使用了来自大型电子医疗数据库——法国国家卫生数据系统（Système National des Données de Santé，SNDS）的匿名数据。纳入了2023年1月1日至2023年12月31日期间所有65岁及以上的人群。根据PIM标准（2023年美国老年医学会Beers标准和REMEDI[e]S工具）确定抗胆碱能和镇静药物的配药情况。从患者数量和百分比方面评估了研究人群以及按年龄（65 - 84岁和85岁及以上）和居住地点（居家患者和机构化患者）亚组划分的抗胆碱能或镇静药物的流行情况。
本研究纳入了16,938,152名65岁及以上的患者（55%为女性）。在所有患者中，79.8%的患者年龄在65至84岁之间，20.2%的患者年龄在85岁及以上。大多数患者居家生活（97.0%），3.0%的患者住在机构中。所有患者中抗胆碱能或镇静药物的流行率为32.8%，65 - 84岁患者中为32.3%，85岁及以上患者中为34.8%，居家患者中为32.1%，机构化患者中为54.5%。最常配给的抗胆碱能或镇静药物是奥沙西泮（5.27%）、阿普唑仑（5.27%）、佐匹克隆（4.85%）、溴西泮（4.23%）、甲哌氯丙嗪（2.88%）、帕罗西汀（2.70%）、奈福泮（2.57%）和羟嗪（2.17%）。
本研究强调，尽管PIM标准不断发展和定期更新，但老年人中应避免使用的抗胆碱能和镇静药物仍经常被开具处方（撤药）。未来需要开展研究来评估这是否导致使用这些药物的老年人的结局恶化，并且应制定新的举措以进一步促进开处方者和药剂师减少此类药物的开具（撤药）。
