A Pharmacoepidemiologic Study of Community-Dwelling, Disabled Older Women: Factors Associated With Medication Use
A Pharmacoepidemiologic Study of Community-Dwelling, Disabled Older Women: Factors Associated With Medication Use
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DOI：
10.1016/j.amjopharm.2010.06.003
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发表时间：
2010-06-01
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影响因子：
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通讯作者：
Fried, Linda P.
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文献类型：
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作者：
Crentsil, Victor;Ricks, Michelle O.;Fried, Linda P.
背景：虽然残疾老年人可能是药物不良事件（ADEs）风险最高的成人亚群之一，但关于他们使用药物的可靠数据有限。目的：本研究的目的是描述社区居住的残疾老年妇女药物使用的程度和模式，并确定与该人群药物使用相关的因素。方法：对来自妇女健康与衰老研究I （WHAS I）的药物使用基线数据进行横断面分析。WHAS I是一项针对1002名年龄在bb0 = 65岁的社区居住女性的观察性研究，这些女性自我报告在4个身体功能领域中至少有2个存在困难（即上肢功能、活动能力、自我护理和社区独立生活所需的更高功能任务）。在对他们的处方药和非处方药（OTC）进行描述性分析后，使用广义线性模型确定了参与者特征与药物利用之间的关联。结果：975名参与者中，580名（59.5%）使用>= 5种药物，115名（11.8%）使用>= 10种药物（处方和otc）。处方药的平均用药次数为3.9次，非处方药的平均用药次数为1.9次。心血管药物和镇痛药分别是最常用的处方药和非处方药。具有完整结局和协变量数据的参与者（n = 803）被纳入多变量分析。癌症与总用药增加13%相关（95% CI, 1.00-1.27）。多病（1.08,95% CI, 1.02 -1.15），虚弱（1.13,95% CI, 1.02-1.26），精神状态检查分数高（1.03,95% CI, 1.01-1.05），充血性心力衰竭（CHF） （1.39, 95% CI, 1.23-1.58），心绞痛（1.27,95% CI, 1.12-1.44），慢性阻塞性肺疾病（COPD） （1.20, 95% CI, 1.05-1.37），糖尿病（DM） （1.24, 95% CI, 1.07-1.43），购买个人物品如药品和盥洗用品困难(1.20；95% CI, 1.06-1.35)和拥有健康保险（1.21;95% CI, 1.04-1.40）或处方计划（1.16;95% CI, 1.05-1.29）与处方药使用增加独立相关。诊断为手骨关节炎（1.29;95% CI, 1.12- 1.49）和有配偶（1.19;95% CI, 1.01-1.40）与非处方药使用增加相关。DM患者（0.78;95% CI, 0.65-0.94）、非裔美国人（0.70;95% CI, 0.60-0.82）和购物有困难的人（0.85;95% CI, 0.72-0.99）比没有这些特征的参与者使用更少的otc。结论：本研究中大多数残疾老年妇女在基线时服用>= 5的药物，这可能使她们处于ade的高风险中。患有多种疾病、虚弱、心力衰竭、心绞痛、糖尿病、慢性阻塞性肺病、癌症和日常生活工具活动困难的患者是多种药物干预的目标亚群。[J] .中华老年医学杂志，2010;8:215-224
Background: Although disabled older adults may be among the subpopulation of adults with the highest risk for adverse drug events (ADEs), reliable data on their use of medications are limited.Objectives: The aims of this study were to describe the extent and patterns of medication use in community-dwelling, disabled older women, and to identify factors associated with medication use in this population.Methods: Cross-sectional analyses of baseline data on medication use from the Women's Health and Aging Study I (WHAS I) were performed. WHAS I was an observational study of 1002 community-dwelling women aged >= 65 years who self-reported difficulty in at least 2 of 4 domains of physical functioning (ie, upper-extremity functions, mobility, self-care, and higher functioning tasks needed for independent living in the community). After descriptive analyses of their prescription and over-the-counter (OTC) drugs, associations between participants' characteristics and medication utilization were determined, using generalized linear models.Results: Of the 975 participants, 580 (59.5%) used >= 5 medications and 115 (11.8%) used >= 10 medications (prescriptions and OTCs). The mean number of medications used was 3.9 for prescription drugs and 1.9 for OTC drugs. Cardiovascular drugs and analgesics were the most frequently used prescription and OTC drugs, respectively. Participants with complete outcome and covariate data (n = 803) were included in the multivariate analyses. Cancer was associated with a 13% increase in total medication use (95% CI, 1.00-1.27). Multimorbidity (1.08; 95% CI, 1.02 -1.15), frailty (1.13; 95% CI, 1.02-1.26), high Mini-Mental State Examination score (1.03; 95% CI, 1.01-1.05), congestive heart failure (CHF) (1.39; 95% CI, 1.23-1.58), angina (1.27; 95% CI, 1.12-1.44), chronic obstructive pulmonary disease (COPD) (1.20; 95% CI, 1.05-1.37), diabetes mellitus (DM) (1.24; 95% CI, 1.07-1.43), difficulty with shopping for personal items such as medicines and toiletries (1.20; 95% CI, 1.06-1.35), and possession of health insurance (1.21; 95% CI, 1.04-1.40) or a prescription plan (1.16; 95% CI, 1.05-1.29) were independently associated with increased use of prescription drugs. A diagnosis of osteoarthritis of the hands (1.29; 95% CI, 1.12- 1.49) and having a spouse (1.19; 95% CI, 1.01-1.40) were associated with increased use of OTC drugs. Participants with DM (0.78; 95% CI, 0.65-0.94), African Americans (0.70; 95% CI, 0.60-0.82), and those who had difficulty shopping (0.85; 95% CI, 0.72-0.99) used fewer OTCs than did participants without these characteristics.Conclusions: Most of the disabled older women in this study took >= 5 medications at baseline, potentially putting them at high risk for ADEs. Those with multimorbidity, frailty, CHF, angina, DM, COPD, cancer, and difficulty with instrumental activities of daily living are target subpopulations for polypharmacy intervention. (Am J Geriatr Pharmacother. 2010;8:215-224) (C) 2010 Excerpta Medica Inc.