Avorn J, Gurwitz J H
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Ann Intern Med. 1995 Aug 1;123(3):195-204. doi: 10.7326/0003-4819-123-3-199508010-00007.
Some of the most intensive pharmacotherapy today occurs in nursing homes in very complex and vulnerable patients. The nursing home provides an opportunity for highly effective drug use, but it also presents risks for polypharmacy and adverse events. Nursing homes are complex social institutions, in which physicians, nurses, consultant pharmacists, other health care professionals, aides, and administrators must interact to make decisions about drug use for patients who generally are frail and have numerous comorbid conditions. Federal regulations have recently been implemented to direct the ways in which specific drugs are to be used in this setting. The nursing home environment can present an ideal opportunity for comprehensive drug regimen review, an exercise too often neglected in the care of elderly patients in all clinical settings. Psychoactive medications, analgesics, and laxatives are examples of drugs that should receive such review. The possible underuse of drug therapies that may be beneficial to nursing home residents, including antidepressant, antihypertensive, and antithrombotic agents; calcium supplements; and vaccines, must be further quantified and must receive increased attention. Morbidity and functional incapacity can be substantially reduced by applying currently established principles of geriatric pharmacology in the nursing home setting, but enormous gaps still exist in the knowledge base necessary to guide this aspect of geriatric medical practice. Data on the efficacy, toxicity, and cost-effectiveness of pharmacotherapeutic choices in nursing home patients are in short supply; considerably more clinical and epidemiologic research is needed to define the relations between the benefits and risks of drugs for this unique population.
如今，一些最密集的药物治疗发生在养老院中非常复杂且脆弱的患者身上。养老院为高效用药提供了机会，但也存在多重用药和不良事件的风险。养老院是复杂的社会机构，医生、护士、药剂师顾问、其他医疗保健专业人员、护工和管理人员必须相互协作，为通常体弱且患有多种合并症的患者做出用药决策。最近已实施联邦法规来指导在这种情况下特定药物的使用方式。养老院环境可以为全面审查药物治疗方案提供理想机会，而在所有临床环境中，老年患者护理中常常忽视这项工作。精神活性药物、镇痛药和泻药等药物都应接受此类审查。可能对养老院居民有益的药物疗法，包括抗抑郁药、抗高血压药和抗血栓形成药物、钙补充剂和疫苗等，其使用不足的情况必须进一步量化，并应得到更多关注。通过在养老院环境中应用当前既定的老年药理学原则，可以大幅降低发病率和功能丧失，但在指导老年医学实践这一方面所需的知识库中仍存在巨大差距。关于养老院患者药物治疗选择的疗效、毒性和成本效益的数据短缺；需要更多的临床和流行病学研究来确定药物对这一特殊人群的利弊关系。
