Comorbidity profile of dementia patients in primary care: Are they sicker?
Comorbidity profile of dementia patients in primary care: Are they sicker?
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DOI：
10.1111/j.1532-5415.2005.00543.x
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发表时间：
2006-01-01
影响因子：
6.3
通讯作者：
Hendrie, HC
中科院分区：
文献类型：
--
作者：
Schubert, CC;Boustani, M;Hendrie, HC
目的：比较患有和不患有痴呆症的老年患者在初级保健中的医疗合并症。设计：横断面研究。设置：Wishard Health Services，包括一所大学附属的城市公立医院和印第安纳波利斯的七个社区初级保健实践中心。伙伴：印第安纳州印第安纳波利斯七个初级保健中心的313名65岁及以上的患者。测量：一个专家小组根据国际疾病分类第10版标准诊断痴呆。使用10种医生诊断的慢性并存疾病和慢性病评分(CDS)对共病进行评估。结果：到初级保健的痴呆患者平均有2.4种慢性疾病，接受了5.1种药物治疗。在这种情况下，大约50%的痴呆症患者至少服用一种抗胆碱能药物，20%的患者至少开一种精神药物。在调整了患者的年龄、种族和性别后，患有痴呆症和不患有痴呆症的患者有相似的共病水平(平均慢性病数量，2.4vs2.3，P=.66；平均CDS，5.8vs6.2，P=.83)。结论：在初级保健中有痴呆和没有痴呆的老年人中，多种医学并存的情况很常见。尽管有胆碱能缺陷，但相当大比例的痴呆症患者会接触到抗胆碱能药物。需要结合这种医学复杂性的护理模式，以改进初级保健中的痴呆症治疗。
OBJECTIVES: To compare the medical comorbidity of older patients with and without dementia in primary care.DESIGN: Cross-sectional study.SETTING: Wishard Health Services, which includes a university-affiliated, urban public hospital and seven community-based primary care practice centers in Indianapolis.PARTICIPANTS: Three thousand thirteen patients aged 65 and older attending seven primary care centers in Indianapolis, Indiana.MEASUREMENTS: An expert panel diagnosed dementia using International Classification of Diseases, 10th Revision, criteria. Comorbidity was assessed using 10 physician-diagnosed chronic comorbid conditions and the Chronic Disease Score (CDS).RESULTS: Patients with dementia attending primary care have on average 2.4 chronic conditions and receive 5.1 medications. Approximately 50% of dementia patients in this setting are exposed to at least one anticholinergic medication, and 20% are prescribed at least one psychotropic medication. After adjusting for patients' age, race, and sex, patients with and without dementia have a similar level of comorbidity (mean number of chronic medical conditions, 2.4 vs 2.3, P=.66; average CDS, 5.8 vs 6.2, P=.83).CONCLUSION: Multiple medical comorbid conditions are common in older adults with and without dementia in primary care. Despite their cholinergic deficit, a substantial proportion of patients with dementia are exposed to anticholinergic medications. Models of care that incorporate this medical complexity are needed to improve the treatment of dementia in primary care.