Chau Ho Cheung, Zhang Kexin, Tai Bik-Wai Bilvick, Hui Isaac Shing Yan, Ma Hon Ming, Wong Martin Chi Sang, Chiang Sau Chu, Cheung Yin Ting
Hong Kong Pharmaceutical Care Foundation Limited, Room 703-704, 7th Floor, CRE Center, 889 Cheung Sha Wan Road, Kowloon, Hong Kong SAR, China.
School of Public Health, Fudan University, Shanghai, China.
BMC Geriatr. 2025 May 6;25(1):314. doi: 10.1186/s12877-025-05989-4.
Many older adults living in Resident Care Homes for the Elderly (RCHEs) are at risk of polypharmacy and the use of potentially inappropriate medication (PIM). Few studies have evaluated the prevalence and consequences of PIM use among older adults living in RCHEs. The objectives of this study are (1) to evaluate the prevalence of PIM use in 29 RCHEs in Hong Kong, and (2) to investigate the association between PIM use and hospitalization in this population.
This is a prospective, observational, cohort study which utilized final-administered medication data from RCHEs that participated in a medication management program. Data on the medications administered to all residents living in the participating RCHEs were extracted from the SafeMed Medication Management System (SMMS), which is a purpose-built Information Technology supporting the entire medication management process at RCHEs. The outcome of interest is the 12-month period prevalence of PIM use (January 1 to December 31, 2023), which was obtained by comparing the medication data with the 2023 Beers criteria. Hospital admissions during the study period were extracted from the SMMS.Multivariable logistic regression was conducted to investigate the association between PIM use and hospital admissions.
We included 6,346 residents (age 82.9 ± 8.6 years; female 61.9%). The average number of current medications was 6.8 ± 7.4. Over half (51.5%) of residents had polypharmacy (≥ 5 medications). The 12-month period prevalence of PIM use was 34.5%. Among the residents with PIMs, 65.1%, 25.5% and 9.4% used 1, 2 and > 2 PIMs, respectively. Residents with PIMs were associated with higher rates of hospitalization (Odds Ratio [OR] 1.73, 95% confidence interval [CI] 1.54 to 1.69), after adjusting for age, sex and comorbidities. The number of PIMs was significantly associated with higher risk of hospitalization (OR: 2.17, 95% CI: 1.82 to 2.59 for > 1 PIMs vs. 0).
The use of PIM was observed in one-third of older adults living in RCHEs, and was associated with an increased risk of hospitalization. Our findings highlighted the urgent need for strategies to improve clinicians' awareness of PIMs and their adverse impact, and to implement pharmacist-led medication reviews in RCHEs.
许多居住在安老院舍的老年人存在多重用药及使用潜在不适当药物（PIM）的风险。很少有研究评估居住在安老院舍的老年人中PIM使用的患病率及后果。本研究的目的是：（1）评估香港29所安老院舍中PIM使用的患病率；（2）调查该人群中PIM使用与住院之间的关联。
这是一项前瞻性观察队列研究，利用参与药物管理项目的安老院舍的最终用药数据。从SafeMed药物管理系统（SMMS）中提取参与研究的安老院舍中所有居民的用药数据，该系统是一个专门构建的信息技术系统，支持安老院舍的整个药物管理流程。感兴趣的结局是PIM使用的12个月期间患病率（2023年1月1日至12月31日），通过将用药数据与2023年Beers标准进行比较得出。研究期间的住院情况从SMMS中提取。进行多变量逻辑回归以调查PIM使用与住院之间的关联。
我们纳入了6346名居民（年龄82.9±8.6岁；女性占61.9%）。当前平均用药数量为6.8±7.4种。超过一半（51.5%）的居民存在多重用药（≥5种药物）。PIM使用的12个月期间患病率为34.5%。在使用PIM的居民中，分别有65.1%、25.5%和9.4%使用1种、2种和>2种PIM。在调整年龄、性别和合并症后，使用PIM的居民住院率更高（比值比[OR]1.73，95%置信区间[CI]1.54至1.69）。PIM的数量与更高的住院风险显著相关（对于>1种PIM与0种PIM相比，OR：2.17，95%CI：1.82至2.59）。
在居住于安老院舍的老年人中，三分之一的人使用了PIM，且这与住院风险增加相关。我们的研究结果凸显了迫切需要采取策略来提高临床医生对PIM及其不良影响的认识，并在安老院舍实施由药剂师主导的药物审查。
