老年住院患者衰弱与潜在不适当用药之间的关联：一项横断面研究。
Association Between Frailty and Use of Potentially Inappropriate Medications in Elderly Hospitalized Patients: A Cross-Sectional Study.
作者信息
Morisaki Yukako, Maeda-Minami Ayako, Sato Masaki, Izumi Sayaka, Suzuki Masanori, Funakoshi Ryohkan, Mano Yasunari
机构信息
Faculty of Pharmaceutical Sciences, Tokyo University of Science, Tokyo, Japan.
Faculty of Pharmaceutical Sciences, Tokyo University of Science, Tokyo, Japan;
出版信息
In Vivo. 2025 Sep-Oct;39(5):2986-2992. doi: 10.21873/invivo.14099.
BACKGROUND/AIM: In a super-aging society, understanding frailty and potentially inappropriate medication (PIM) use is crucial for appropriate drug use in older persons. This study evaluated the association between frailty and PIMs in elderly hospitalized patients.
PATIENTS AND METHODS
Patients ≥65 years who were admitted to Kameda Medical Center between October 2016 and 2017 were included. Frailty was defined as a Barthel Index <90 or Mini-Mental State Examination <18; patients not meeting these criteria were classified as non-frail. PIMs were defined according to the 2015 Beers Criteria. When PIMs were used at least once during hospitalization, patients were defined as PIM users; otherwise, they were defined as non-users. PIM users in both the frail and non-frail groups were compared through logistic regression analysis by adjusting for background factors and calculating adjusted odds ratios and 95% confidence intervals. As a sensitivity analysis, the frail group was subdivided into those with mild frailty and those with severe frailty, and the proportion of PIM users with mild frailty, severe frailty, and those without frailty were compared.
RESULTS
The proportion of PIM users did not significantly differ between the groups with and without frailty (adjusted odds ratio=1.29, 95% confidence interval=0.84-1.98). As a result of sensitivity analysis, the proportion of PIM use was significantly higher in the group with severe frailty than in the non-frail group (adjusted odds ratio=12.0, 95% confidence interval=1.76-81.3).
CONCLUSION
This study found no significant difference in PIM use between frail and non-frail elderly Japanese inpatients. However, sensitivity analysis revealed higher PIM use in those with severe frailty than in those who were non-frail. Therefore, this result implies that patients with severe frailty must be prescribed drugs appropriately, taking into account the background of each patient.
背景/目的：在超老龄化社会中，了解衰弱和潜在不适当用药（PIM）对于老年人合理用药至关重要。本研究评估了老年住院患者中衰弱与PIM之间的关联。
患者与方法
纳入2016年10月至2017年期间入住镰田医疗中心的65岁及以上患者。衰弱定义为巴氏指数<90或简易精神状态检查表<18；未达到这些标准的患者分类为非衰弱患者。PIM根据2015年《Beers标准》定义。当患者在住院期间至少使用过一次PIM时，定义为PIM使用者；否则，定义为非使用者。通过对背景因素进行调整并计算调整后的比值比和95%置信区间，采用逻辑回归分析比较衰弱组和非衰弱组中的PIM使用者。作为敏感性分析，将衰弱组细分为轻度衰弱者和重度衰弱者，并比较轻度衰弱、重度衰弱和非衰弱者中PIM使用者的比例。
结果
衰弱组和非衰弱组之间PIM使用者的比例无显著差异（调整后的比值比=1.29，95%置信区间=0.84-1.98）。敏感性分析结果显示，重度衰弱组中PIM的使用比例显著高于非衰弱组（调整后的比值比=12.0，95%置信区间=1.76-81.3）。
结论
本研究发现，日本衰弱和非衰弱老年住院患者在PIM使用方面无显著差异。然而，敏感性分析显示，重度衰弱者比非衰弱者的PIM使用率更高。因此，该结果表明，对于重度衰弱患者，必须根据每位患者的背景合理开药。
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