Potentially Inappropriate Medication Use in Older Adults with Alzheimer's Disease and Related Dementias Living in the Community: A Cross-Sectional Analysis.
Potentially Inappropriate Medication Use in Older Adults with Alzheimer's Disease and Related Dementias Living in the Community: A Cross-Sectional Analysis.
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DOI：
10.1007/s40801-021-00265-4
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发表时间：
2021-12
影响因子：
--
通讯作者：
Moga DC
中科院分区：
文献类型：
--
作者：
Vickers LE;Martinez AI;Wallem AM;Johnson C;Moga DC
随着美国老年人口的增加，患有阿尔茨海默病和相关痴呆症 (ADRD) 的人数也在增加。根据比尔斯标准，老年人很容易受到潜在不适当药物的影响；然而，一些药物仍然不符合建议。我们的目标是描述患有或不患有 ADRD 的老年人中与认知障碍或衰退（称为 Cog-PIM）相关的潜在不当药物 (PIM) 使用，并调查在美国门诊护理（即门诊护理）中，Cog-PIM 报告的几率是否因 ADRD 状态而异。使用 2016 年年龄 ≥ 65 岁成年人非围手术期门诊门诊护理的全国代表性样本进行横断面分析（n = 218,182,131）。数据来自全国流动医疗调查。根据 2015 年 Beers Criteria 建议中的定义，Cog-PIM 被确定为可能不适合患有认知障碍或痴呆症的老年人的药物。 ADRD 状态由临床医生报告使用自由文本、ADRD 标记或是否存在指示痴呆的诊断代码来确定。使用多变量逻辑回归来估计总体和按药物类别使用 Cog-PIM 的几率。 2016 年，2.1% (n = 4,651,563) 的门诊患者是患有 ADRD 的老年人，其中 33.2% 报告至少有一种 Cog-PIM。 20.5% 的 ADRD 就诊中发现了抗胆碱能 Cog-PIM，而非 ADRD 就诊的比例为 8.1%。在 ADRD 就诊中，有 15.5% 的人注意到抗精神病药物 PIM，而在非 ADRD 就诊中，这一比例为 0.8%。 10.9% 的 ADRD 就诊和 10.7% 的非 ADRD 就诊报告了苯二氮卓类和非苯二氮卓类受体激动剂安眠药（Z 药物）Cog-PIM。 ADRD 状态是 Cog-PIM 报告总体（调整后比值比 [aOR] 2.74 [95% 置信区间 {CI} 1.20–6.27]）和抗胆碱能药物和抗精神病药物的显着预测因子（aOR 3.35 [95% CI 1.24–9.03] 和 aOR 22.80 [95% CI 5.80–89.50]，分别）。这项研究表明，患有 ADRD 的老年人使用 Cog-PIM 的比例很高，并且使用 Cog-PIM 的几率增加。未来的工作应调查门诊护理环境中的机会，以更安全地开药并降低 Cog-PIM 的升级。
With the older adult population in the USA increasing, so is the population of those with Alzheimer’s disease and related dementias (ADRD). Older adults are vulnerable to the effects of potentially inappropriate medications as established by the Beers Criteria; however, some medications continue to be prescribed against recommendations. Our objectives were to describe potentially inappropriate medication (PIM) use linked to cognitive impairment or decline (referred to as Cog-PIM) in older adults with and without ADRD and to investigate whether the odds of Cog-PIM report differ by ADRD status in ambulatory care (i.e., outpatient care) in the USA. A cross-sectional analysis was performed using a nationally representative sample of non-perioperative, office-based ambulatory care visits by adults aged ≥ 65 years in 2016 (n = 218,182,131). Data were collected from the National Ambulatory Medical Care Survey. Cog-PIMs were identified as defined in the 2015 Beers Criteria recommendations for medications that may be potentially inappropriate in older adults with cognitive impairment or dementia. ADRD status was determined by clinician report using free text, the ADRD flag, or the presence of a diagnosis code indicating dementia. Multivariable logistic regressions were used to estimate the odds of Cog-PIM use overall and by medication class. In 2016, 2.1% (n = 4,651,563) of outpatient visits were made by older adults with ADRD, 33.2% of which reported at least one Cog-PIM. Anticholinergic Cog-PIMs were noted in 20.5% of ADRD visits compared with 8.1% of non-ADRD visits. Antipsychotic PIMs were noted in 15.5% of ADRD visits compared with 0.8% of non-ADRD visits. Benzodiazepine and non-benzodiazepine receptor agonist hypnotic (Z drug) Cog-PIMs were reported in 10.9% of ADRD visits and 10.7% of non-ADRD visits. ADRD status was a significant predictor of Cog-PIM report overall (adjusted odds ratio [aOR] 2.74 [95% confidence interval {CI} 1.20–6.27]) and for anticholinergics and antipsychotics specifically (aOR 3.35 [95% CI 1.24–9.03] and aOR 22.80 [95% CI 5.80–89.50], respectively). This study demonstrated a high prevalence of Cog-PIM use and increased odds of Cog-PIM use in older adults with ADRD. Future work should investigate opportunities in the ambulatory care setting for safer prescribing and de-escalation of Cog-PIMs.
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影响因子：
4.1
作者：
Andersen F;Viitanen M;Halvorsen DS;Straume B;Engstad TA
通讯作者：
Engstad TA
影响因子：
4
作者：
Cross, Amanda J.;George, Johnson;Elliott, Rohan A.
通讯作者：
Elliott, Rohan A.
影响因子：
6.3
作者：
Radcliff, Sue;Yue, Jirong;Beers, Mark H.
通讯作者：
Beers, Mark H.
影响因子：
4
作者：
Barry, Heather E.;Cooper, Janine A.;Hughes, Carmel M.
通讯作者：
Hughes, Carmel M.
影响因子：
6.3
作者：
Bloom HG;Ahmed I;Alessi CA;Ancoli-Israel S;Buysse DJ;Kryger MH;Phillips BA;Thorpy MJ;Vitiello MV;Zee PC
通讯作者：
Zee PC