The association of inappropriate drug use with hospitalisation and mortality - A population-based study of the very old
The association of inappropriate drug use with hospitalisation and mortality - A population-based study of the very old
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DOI：
10.2165/00002512-200522010-00005
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发表时间：
2005-01-01
期刊：
影响因子：
2.8
通讯作者：
Fastbom, J
中科院分区：
文献类型：
--
作者：
Klarin, I;Wimo, A;Fastbom, J
背景和目的：不恰当的处方是老年人药物不良反应（ADR）的一个重要且可能可预防的危险因素，医院研究表明很大一部分入院是由ADR引起的。然而，人们对于不适当药物使用 (IDU) 如何影响人口层面的老年人知之甚少。本研究的目的是探讨 3 年随访期间 IDU 与老年人群急性住院治疗和死亡率之间的可能关联。 患者和方法：使用了瑞典 Kungsholmen 项目内一项农村、基于人群的纵向队列研究的数据。 785 名年龄大于或等于 75 岁的参与者拥有完整的药物使用数据和在 1995 年至 1998 年基线调查期间收集的选定协变量，并被纳入该研究。收集纳入后 3 年内的住院和死亡率数据。使用适用于现有数据的基于共识的标准（源自比尔标准、加拿大标准和老年人药物相关发病率的临床指标）在基线上评估注射吸毒者，并添加潜在危险的药物重复和其他潜在危险的药物相互作用。根据研究标准，IDU 被定义为存在至少一种不适当的药物治疗方案。分别使用逻辑回归和比例风险模型来研究IDU与住院和死亡率的关联。结果：91.6%的研究人群定期或“按需”使用药物，平均每人使用4.4种药物。 IDU 很常见，患病率为 18.6%，在调整年龄、性别、教育程度、合并症、日常生活活动 (ADL) 依赖性和吸烟后，与社区老年人中至少一次急性住院的风险增加相关。比值比为 2.72 (95% CI 1.64, 4.51)。调整年龄、性别、住房、教育、合并症、ADL依赖、吸烟和体重指数后，未发现与死亡率相关。结论：复合用药和注射吸毒在老年人中很常见，注射吸毒与社区老年人的急性住院相关。尽管本研究设计无法确定因果关系，但结果与医院研究中发现的药物相关入院率较高的情况一致。我们的研究结果表明，根据现有知识，通过向医生提供信息和谨慎开药来减少注射吸毒者是可取的。
Background and objective: Inappropriate prescribing is an important and possibly preventable risk factor for adverse drug reactions (ADRs) in the elderly, and hospital-based studies have shown that a large proportion of admissions is a result of ADRs. However, little is known about how inappropriate drug use (IDU) affects the elderly at the population level. The aim of this study was to explore possible associations of IDU with acute hospitalisation and mortality in an elderly population during 3 years of follow-up.Patients and methods: Data from a rural, population-based, longitudinal cohort study within the Kungsholmen Project, Sweden, were used. 785 participants, greater than or equal to75 years of age, had complete data on drug use and selected covariates collected during baseline investigation from 1995 to 1998, and were included in the study. Hospitalisation and mortality data during 3 years after inclusion were collected. IDU was assessed at baseline using consensus-based criteria applicable to available data (derived from Beers' criteria, Canadian criteria and clinical indicators of drug-related morbidity in older adults) with the addition of potentially dangerous drug duplication and additional potentially hazardous drug-drug interactions. IDU was defined as presence of at least one inappropriate drug regimen according to the study criteria. Logistic regression and proportional hazard models were used, respectively, to study the association of IDU with hospitalisation and mortality.Results: Drugs were used on a regular or 'as needed' basis by 91.6% of the study population, with a mean of 4.4 drugs per person. IDU was common, with a prevalence of 18.6% and was associated with increased risk of at least one acute hospitalisation in community-living elderly, after adjustment for age, sex, education, comorbidity, dependency in activities of daily living (ADL) and smoking. The odds ratio was 2.72 (95% CI 1.64, 4.51). No association with mortality was found, after adjustment for age, sex, housing, education, comorbidity, ADL-dependency, smoking and body mass index.Conclusion: Polypharmacy and IDU are common among the elderly and IDU is associated with acute hospitalisation in community-living elderly. Although causality cannot be established with this study design, the results are consistent with the high prevalence of drug-related hospital admissions found in hospital-based studies. Our results indicate that it is desirable with current knowledge, to reduce IDU through information to physicians and careful prescribing.