Analgesic Use and Frailty among Community-Dwelling Older People A Population-Based Study
Analgesic Use and Frailty among Community-Dwelling Older People A Population-Based Study
复制标题
DOI：
10.1007/s40266-012-0046-8
复制
发表时间：
2013-01-01
期刊：
影响因子：
2.8
通讯作者：
Hartikainen, Sirpa A.
中科院分区：
文献类型：
--
作者：
Koponen, Marjaana P. H.;Bell, J. Simon;Hartikainen, Sirpa A.
背景虚弱的老年人对压力源的反应能力下降，因此可能更容易受到与治疗不当的疼痛相关的不良事件的影响。相反，衰老和虚弱相关的药代动力学和药效学变化可能使体弱多病的老年人更易发生镇痛药的不良事件。目的探讨社区老年人使用镇痛药是否与虚弱状态相关，以及不同虚弱人群使用镇痛药的类型是否存在差异。方法研究人群为605名年龄在0 ~ 75岁的社区居民。在标准化护士访谈中收集人口统计、诊断和药物使用数据。根据心血管健康研究的虚弱标准（体重减轻、虚弱、疲惫、行动迟缓和低体力活动），参与者被分为虚弱、体弱或健壮。总体而言，11.4% （n = 69）的研究参与者虚弱，49.4% （n = 299）的研究参与者虚弱前期。处方和非处方止痛药的使用在体弱多病的老年人中（68.1%）高于体弱多病前（54.5%）和体弱多病老年人（40.5%）（p < 0.001）。在多变量分析中，虚弱与止痛药的使用呈正相关（优势比2.96;95% CI 1.38-6.36）。然而，虚弱的镇痛药使用者（46.7%）比强壮的镇痛药使用者（23.2%）更有可能希望他们的医生更加关注疼痛管理。在体弱（78.7%）和体弱前期（63.2%）中，最普遍的镇痛药是对乙酰氨基酚（扑热息痛），而在强壮（60.4%）的镇痛药使用者中，最普遍的镇痛药是非甾体抗炎药。虚弱（60.3%）和虚弱前期（58.1%）的参与者比强壮（44.7%）的参与者更有可能报告肌肉骨骼疼痛。在老年人中，33.0%、23.1%和4.9%（分别）未使用任何镇痛药。结论：体弱多病与较高的镇痛药使用率有关。由于体弱多病的老年人可能更容易受到不良事件的影响，因此需要谨慎选择止痛剂。临床医生应更加重视疼痛管理，以确保足够的疼痛缓解。
Background Frail older people have a decreased ability to respond to stressors and may therefore be more susceptible to adverse events related to inadequately treated pain. Conversely, aging- and frailty-related changes in pharmacokinetics and pharmacodynamics may predispose frail older people to adverse events of analgesics.Objective The aim of this study was to explore whether analgesic use is associated with frailty status and whether there are differences in the types of analgesics used between frailty groups among community-dwelling older people.Methods The study population consisted of 605 community-dwelling people aged >75 years. Demographic, diagnostic and drug use data were collected during standardized nurse interviews. Participants were classified as frail, pre-frail or robust using the Cardiovascular Health Study frailty criteria (weight loss, weakness, exhaustion, slowness and low physical activity).Results Overall, 11.4 % (n = 69) of the study participants were frail and 49.4 % (n = 299) were pre-frail. The prevalence of prescription and non-prescription analgesic use was higher among frail (68.1 %) than among pre-frail (54.5 %) and robust (40.5 %) older people (p < 0.001). In multivariate analyses, frailty was positively associated with analgesic use (odds ratio 2.96; 95 % CI 1.38-6.36). However, frail analgesic users (46.7 %) were more likely to want their physicians to pay greater attention to pain management than robust (23.2 %) analgesic users. The most prevalent analgesic was acetaminophen (paracetamol) among frail (78.7 %) and pre-frail (63.2 %), and NSAIDs among robust (60.4 %) analgesic users. Frail (60.3 %) and pre-frail (58.1 %) participants were more likely to report musculoskeletal pain than robust (44.7 %) participants. Of robuk, pre-frail and frail older people 33.0 %, 23.1 % and 4.9 % (respectively) did not use any analgesics to treat their paid.Conclusions Frailty was associated with a higher prevalence of analgesic use. As frail older people may be more susceptible to adverse events, careful selection of analgesics is warranted. Clinicians should pay more attention to pain management to ensure adequate pain relief.