Prescribing for the elderly.
Prescribing for the elderly.
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为老年人开药。
作者：
M. Bliss
一般来说，今天英国的处方是一团糟：NHS每年在药物上的支出是多少？500米; 1处方率如下：55%的男性人口每年至少接受一次处方2; 65%的女性人口每年至少接受一次处方2; 33%的45-59岁女性接受精神药物2; 75岁及以上妇女中有37%接受精神药物2; 75岁及以上人口中有75%接受某种药物2;三分之二接受一至三种药物，三分之一接受四至六种药物3;所有成年人中有25%的人在服用一年多前首次开具的药物4; 75%的处方是重复处方4;在老年门诊诊所看到的患者药瓶中有50%没有剂量说明（个人观察）;入住老人科病房的病人中，有80%正在接受药物3;对于这些病人中的大部分，以及在老人科门诊诊所就诊的病人，我们无法确定这些药物是什么; 10%的老年病房入院病例是由于药物引起的医源性疾病。3医生和患者都需要为每种疾病开处方并不是什么新鲜事。读过乔治艾略特的《米德尔马契》的读者会想起年轻的利德盖特博士和unpopu的斗争。他试图抵制对无用的瓶装水的需求，这给他自己带来了麻烦，与他的同事和病人。在这方面，医生比病人更有责任。研究表明，尽管80-90%的医生希望病人需要处方，但实际上只有30-50%的病人需要处方;其余的人更喜欢检查、建议和保证，但往往是开处方。在过去，安慰剂，或者说是当时真正的药物，常常是令人不快的，但它们很少有今天药物的强大生理作用，也不是那么容易获得的。今天，老年人是现代药物及其管理系统的主要受害者。原因如下：（1）老年人的多种病理，（2）多种药物，（3）老年人对药物和副作用的敏感性增加，（4）医生缺乏老年前？划线，（5）不适当的药物包装和说明，（6）对老年病人的监督不力，以及（7）医院和全科诊所的双重处方制度，这使医生不能对自己的处方负全部责任。
Generally, prescribing in Britain today is in a mess : the annual expenditure of the NHS on drugs is ?500m; expenditure on drugs not taken, "non-compliance," is 3C20m.1 Prescription rates are as follows : 55% of the whole male population receive at least one prescription a year2; 65% of the whole female population receive at least one prescription a year2; 33% of all women aged 45-59 receive psychotrophic drugs2; 37% of all women aged 75 and over receive psychotrophic drugs2; 75% of the whole population aged 75 and over receive drugs of some kind2; two-thirds receive one to three drugs, and one third four to six drugs simultaneously3; 25% of all adults are taking medicines first prescribed more than one year previously4; 75% of prescriptions are repeat prescriptions4; 50% of patient's bottles seen in a geriatric outpatient clinic have no dosage directions (personal observation) ; 80% of patients admitted to geriatric wards are receiving drugs3; for most of these patients, and for patients seen in geriatric outpatient clinics, it is impossible to be certain what the drugs are; and 10% of admissions to geriatric wards are due to iatrogenic disease caused by drugs.3 The need for a prescription for every ill felt by both doctors and patients is not new. Readers of George Eliot's Middlemarch will recall the struggles of young Dr Lydgate and the unpopu? larity that he brought on himself, with both his colleagues and his patients, by trying to resist the demand for useless bottles of physic. In this respect doctors are more culpable than patients. Studies5 have shown that, whereas 80-90% of doctors expect patients to want prescriptions, only 30-50% of patients actually do; the remainder would prefer an examination, advice, and reassurance, but are frequently given a prescription instead. In the past placebos, or the bona-fide medicines of the day, were often unpleasant, but they seldom had the powerful physiological actions of today's drugs, nor were they so freely available. Today the elderly are the main victims of modern drugs and the system by which they are administered. The reasons for this are: (1) multiple pathology of the elderly, (2) polypharmacy, (3) increased sensitivity of the elderly to drugs and side effects, (4) doctors' lack of training in geriatric pre? scribing, (5) unsuitable drug packaging and instructions, (6) poor supervision of elderly patients, and (7) dual prescribing systems in hospitals and in general practice, which prevent doctors from being fully responsible for their own prescribing.