Underuse of medications for chronic diseases in the oldest of community-dwelling older frail Japanese
Underuse of medications for chronic diseases in the oldest of community-dwelling older frail Japanese
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DOI：
10.1111/j.1532-5415.2006.00659.x
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发表时间：
2006-04-01
影响因子：
6.3
通讯作者：
Iguchi, A
中科院分区：
文献类型：
--
作者：
Kuzuya, M;Masuda, Y;Iguchi, A
目的：为了检验以下假设：（1）年龄最大的老年人（>= 85岁）的多种药物使用率（定义为6种或6种以上处方药物）低于年龄较小的老年人（65-84岁）;（2）年龄最大的老年人的有益药物使用率较低;（3）年龄最大的老年人对这些药物的使用不足与身体或认知障碍或共病状况有关。设计：名古屋老年体弱者纵向研究基线资料的横断面研究。地点：以社区为基础。对象：1875名社区老年人（632名男子，1 243名妇女）。这些数据是在患者家中或从护理管理中心的记录中收集的，包括客户的人口统计学特征，抑郁状态评估使用的老年抑郁量表，日常生活的基本活动（ADL），处方药，和医生诊断的慢性疾病的评级的简短版本。在调整ADL、认知功能障碍、共病、抗血栓药物（用于有心血管疾病史的受试者）、乙酰胆碱酯酶抑制剂（用于痴呆患者）和抗抑郁药物（用于抑郁患者）后，观察到高龄老人有益药物使用不足。然而，年龄在85岁及以上的糖尿病和高血压，分别与低血糖和抗高血压药物的使用不足，结论：在社区居住的体弱老年人，多药的比率是最古老的成员比年轻的。对体弱老年人的慢性病/病症未充分使用处方药的情况很常见，但并非对所有病症都如此。
OBJECTIVES: To test the following hypotheses: (1) the rate of polypharmacy, defined as six or more prescribing medications, is lower in the oldest old (>= 85) than in younger older people (65-84); (2) beneficial medication use is lower in the oldest old; (3) the underuse of these medications in the oldest old is associated with physical or cognitive impairment or comorbid conditions.DESIGN: A cross-sectional study of the baseline data from the Nagoya Longitudinal Study for Frail Elderly.SETTING: Community-based.PARTICIPANTS: One thousand eight hundred seventy-five community-dwelling older people (632 men, 1,243 women).MEASUREMENTS: The data, which were collected at the patients' homes or from care-managing center records, included the clients' demographic characteristics, depression status as assessed using the short version of the Geriatric Depression Scale, a rating for basic activities of daily living (ADLs), prescribed medications, and physician-diagnosed chronic diseases.RESULTS: The oldest old had less polypharmacy even after controlling for ADLs and comorbid conditions. The underuse of beneficial medications for the oldest old was observed after adjusting for ADLs, cognitive impairment, comorbid conditions, antithrombotic agents for subjects with a history of cardiovascular diseases, acetylcholinesterase inhibitors for those with dementia, and antidepressants for those with depression. However, being aged 85 and older was not associated with the underuse of hypoglycemic and antihypertensive agents by those with diabetes mellitus and hypertension, respectively.CONCLUSION: Among community-dwelling frail older people, the rate of polypharmacy is lower in the oldest members than in the younger ones. The underuse of prescribed medications for chronic diseases/conditions of frail older people is common but not for all conditions.