Gray S L, Sager M, Lestico M R, Jalaluddin M
School of Pharmacy, University of Washington, Seattle, USA.
J Gerontol A Biol Sci Med Sci. 1998 Jan;53(1):M59-63. doi: 10.1093/gerona/53a.1.m59.
The study objectives were (a) to describe the occurrence, types, and preventability of adverse drug events (ADEs) in hospitalized patients 70 years of age and older; (b) to examine the association between potential risk factors and ADEs; and (c) to examine the relationship of an ADE occurrence and hospital length of stay (LOS) and functional decline.
Consecutive general medical admissions (n = 157) of community-dwelling persons were prospectively monitored daily for ADE occurrence. Admission assessment included demographic factors, cognition, preadmission medication use, and functional status. Discharge assessment included functional status. LOS, discharge diagnoses, and medication use during the hospitalization.
Twenty-three patients (14.6%) experienced 28 probable ADEs, of which 54.2% (13/24) were judged to be potentially preventable. Patients experiencing an ADE had a significantly lower mean Mini-Mental State Examination score (23.6 +/- 4.3 vs 25.5 +/- 3.6, p = .039) and were prescribed significantly more new inpatient medications (4.0 +/- 2.3 vs 2.6 +/- 1.7, p = .01) compared to non-ADE patients. Age, gender, functional status prior to admission, percent with more than four active diagnoses, or number of preadmission medications were not associated with ADE status. Upon discharge, 50.0% of ADE patients experienced a decline in one or more activities of daily living (ADLs), compared with 24.1% of non-ADE patients (p = .017). ADE patients had a longer LOS (8.7 +/- 4.9 vs 6.6 +/- 3.0 days, p = .022) compared to non-ADE patients.
ADEs were associated with number of new inpatient medications and admission cognitive status, but not demographic, disease, or physical function variables. Patients experiencing an ADE were more likely to experience a longer LOS and to decline in ADL function. ADEs may be one factor contributing to functional decline during hospitalization. Future research in this area should include larger samples and multivariable analyses controlling for potential confounders.
本研究的目的是：（a）描述70岁及以上住院患者药物不良事件（ADEs）的发生情况、类型及可预防性；（b）研究潜在风险因素与ADEs之间的关联；（c）研究ADEs的发生与住院时间（LOS）及功能衰退之间的关系。
对连续入住普通内科的社区居民（n = 157）进行前瞻性每日监测，以观察ADEs的发生情况。入院评估包括人口统计学因素、认知情况、入院前用药情况及功能状态。出院评估包括功能状态、LOS、出院诊断及住院期间的用药情况。
23名患者（14.6%）发生了28起可能的ADEs，其中54.2%（13/24）被判定为潜在可预防的。与未发生ADEs的患者相比，发生ADEs的患者简易精神状态检查表平均得分显著更低（23.6±4.3对25.5±3.6，p = 0.039），且新开具的住院药物显著更多（4.0±2.3对2.6±1.7，p = 0.01）。年龄、性别、入院前功能状态、有超过四项活跃诊断的患者百分比或入院前用药数量与ADEs状态无关。出院时，50.0%的ADEs患者出现一项或多项日常生活活动（ADL）能力下降，而未发生ADEs的患者中这一比例为24.1%（p = 0.017）。与未发生ADEs的患者相比，发生ADEs的患者住院时间更长（8.7±4.9天对6.6±3.0天，p = 0.022）。
ADEs与新开具的住院药物数量及入院时的认知状态有关，但与人口统计学、疾病或身体功能变量无关。发生ADEs的患者更有可能住院时间更长且ADL功能衰退。ADEs可能是导致住院期间功能衰退的一个因素。该领域未来的研究应纳入更大样本并进行多变量分析以控制潜在混杂因素。
