Nobili A, Tettamanti M, Frattura L, Spagnoli A, Ferraro L, Marrazzo E, Ostino G, Comelli M
Laboratorio di Neuropsichiatria Geriatrica, Istituto di Ricerche Farmacologiche M. Negri, Milan, Italy.
Ann Pharmacother. 1997 Apr;31(4):416-22. doi: 10.1177/106002809703100405.
To evaluate drug consumption in the elderly aged 75 years or more living at home.
Cross-sectional study.
Old-old (i.e., > or = 75 y) people living in central Turin, a city in northern Italy.
Thirty-four general practitioners (GPs), with 50 or more old-old people in their patient list, randomly chosen among the GPs working in the Unità Socio-Sanitaria Locale I (Local Health Unit I) of Turin; 261 old-old people (135 men and 126 women) randomly selected from the practice records.
Data were collected by the GP through a structured questionnaire during an office visit and by a social worker in a home interview within 14 days of the GP visit. GPs were asked to record every diagnosis and drug currently taken by the patient; social workers were trained in the administration of a structured questionnaire exploring sociodemographic variables, drug use (following the medication inventory strategy), disability, cognitive functions, and depressive symptoms.
Nearly all subjects (95% of the women and 91% of the men) were taking at least 1 drug. The overall number of drugs recorded was 917 (47.1% for men and 52.9% for women), of which 172 (18.8%) were not reported by the GP but were recorded during the social worker's visit. The mean number of drugs was 3.2 for men and 3.8 for women, with a statistically significant difference (p = 0.02), while the mean number of diagnoses was 2.3 and 2.6, respectively. The study of correlates of drug consumption showed a strong association with number of diagnoses at univariate analysis (p < 0.0001, with a linear correlation coefficient of 0.64). No multivariate model showed a clear superiority over the simple one containing only the number of diagnoses in predicting the total number of drugs taken. Cardiovascular, nervous system, and alimentary tract drugs were the most frequently used. A total of 107 subjects (41%) were taking at least 1 unreported drug.
Our study shows high drug consumption among old-old people, with nearly 20% of drugs taken not reported by the GP. These results emphasize the need for an essential therapeutic approach in old-old people, prescribing only drugs of scientifically proven efficacy. Furthermore, the GP must make more effort when collecting a drug history from old-old patients.
评估居家生活的75岁及以上老年人的药物使用情况。
横断面研究。
居住在意大利北部城市都灵市中心的高龄老人（即≥75岁）。
在都灵市第一社会卫生单位工作的全科医生中随机挑选出34名全科医生，其患者名单中有50名或更多高龄老人；从诊疗记录中随机选取261名高龄老人（135名男性和126名女性）。
全科医生在门诊就诊期间通过结构化问卷收集数据，社会工作者在全科医生就诊后14天内进行家访时收集数据。要求全科医生记录患者目前的每一项诊断和所服用的药物；社会工作者接受过管理结构化问卷的培训，该问卷用于探究社会人口统计学变量、药物使用情况（采用药物清单策略）、残疾情况、认知功能和抑郁症状。
几乎所有受试者（95%的女性和91%的男性）至少服用1种药物。记录的药物总数为917种（男性占47.1%，女性占52.9%），其中172种（18.8%）全科医生未报告，但在社会工作者家访时记录到了。男性的平均用药数为3.2种，女性为3.8种，差异有统计学意义（p = 0.02），而平均诊断数分别为2.3个和2.6个。药物使用相关性研究显示，在单因素分析中与诊断数有很强的关联（p < 0.0001，线性相关系数为0.64）。在预测所服用药物总数方面，没有多变量模型显示出比仅包含诊断数的简单模型有明显优势。心血管、神经系统和消化道药物是最常用的。共有107名受试者（41%）至少服用1种未报告的药物。
我们的研究表明高龄老人药物使用量很高，近20%服用的药物未被全科医生报告。这些结果强调了对高龄老人采取基本治疗方法的必要性，仅开具经科学证实有效的药物。此外，全科医生在收集高龄患者用药史时必须更加努力。
