Investigating polypharmacy and drug burden index in hospitalised older people
Investigating polypharmacy and drug burden index in hospitalised older people
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DOI：
10.1111/imj.12203
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发表时间：
2013-08-01
影响因子：
2.1
通讯作者：
McLachlan, A. J.
中科院分区：
文献类型：
--
作者：
Best, O.;Gnjidic, D.;McLachlan, A. J.
目的：调查老年人住院期间多药联用和药物负担指数的变化。第二个目的是检验这两个指标与住院时间和因跌倒或神志不清而住院的时间之间的关系。方法：对澳大利亚悉尼一所大型大学教学医院收治的年龄为65岁并由老年医学或康复团队照顾的患者的病历进行了回顾分析。多药联用的定义是使用五种以上的常规药物。DBI衡量的是接触具有抗胆碱和镇静作用的药物的情况。采用Logistic回归分析研究多药联用与DBI之间的关系。数据采用95%可信区间的优势比来表示。结果：本研究共纳入329名患者。人口的平均年龄(+/-标准差)为84.6+/-7.0岁，其中62%是女性，40%是从养老院入住的。入院时，60%的队列中观察到多药并存，50%的患者暴露于DBI。在住院期间，DBI和多药房暴露减少，但只有服用药物的数量减少了统计意义上的显著幅度(P=0.02)。高DBI(=1)的患者因神志不清而入院的可能性大约是无DBI的患者的三倍(优势比，2.95；95%可信区间，1.34-6.51)。结论：在本研究中，DBI与仅因神志不清入院的风险增加有关。多药联用与任何临床措施无关。
Aims: To investigate the changes in polypharmacy and the drug burden index (DBI) occurring during hospitalisation for older people. The secondary aim was to examine the associations of these two measures with the length of hospital stay and admission for falls or delirium.Methods: A retrospective analysis of patients' medical records was undertaken at a large university teaching hospital (Sydney, Australia) for patients with the age of >= 65 years and admitted under the care of the geriatric medicine or rehabilitation teams. Polypharmacy was defined as the use of more than five regular medications. The DBI measures exposure to drugs with anticholinergic and sedative effects. Logistic regression analysis was conducted to investigate the associations between polypharmacy and DBI with outcome measures. Data are presented using odds ratios with 95% confidence intervals.Results: A total of 329 patients was included in this study. The mean (+/- standard deviation) age of the population was 84.6 +/- 7.0 years, 62% were female and 40% were admitted from residential aged-care facilities. On admission, polypharmacy was observed in 60% of the cohort and DBI exposure for 50%. DBI and polypharmacy exposure decreased during hospitalisation, but only the number of medications taken decreased by a statistically significant margin (P = 0.02). Patients with a high DBI (= 1) were approximately three times more likely to be admitted for delirium than those with no DBI exposure (odds ratio, 2.95; 95% confidence interval, 1.34-6.51).Conclusions: In the present study, DBI was associated with an increased risk of hospital admission for delirium only. Polypharmacy was not associated with any of the clinical measures.