Prevalence and outcomes of use of potentially inappropriate medicines in older people: cohort study stratified by residence in nursing home or in the community
Prevalence and outcomes of use of potentially inappropriate medicines in older people: cohort study stratified by residence in nursing home or in the community
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DOI：
10.1136/bmjqs.2009.039818
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发表时间：
2011-03-01
影响因子：
5.4
通讯作者：
Fahey, T.
中科院分区：
文献类型：
--
作者：
Barnett, K.;McCowan, C.;Fahey, T.
目的：比较住在自己家里的老年患者与住在养老院或养老院的老年患者使用潜在不适当药物（PIMs）的流行程度，并测试暴露于PIMs与死亡率之间的关系。设计：按居住地分层的队列研究。背景：苏格兰泰赛德。参与者：所有年龄在66岁至99岁之间，2005年至2006年在泰赛德居住或死亡的人。主要结果测量：暴露变量为比尔斯标准定义的PIM使用情况。全因死亡率是主要的结局指标。结果：70299人被纳入队列，其中96%暴露于任何药物，31%接受PIM。居住地与接受pim的总风险无关，调整后OR为0.94,95% CI为0.87至1.01。在疗养院中，五种抗抑郁药（包括长效苯二氮卓类药物）的暴露率明显较高，而其他五种抗抑郁药（包括阿米替林和非甾体抗炎药）的暴露率明显较低。在泰赛德所有71个全科诊所中，pim暴露相似（20-46%），并且在调整年龄、性别和多种药物后，与死亡风险增加无关（调整OR 0.98, 95% CI 0.92至1.05）。结论：作者质疑完整的pim清单作为老年人药物安全性指标的有效性，因为三分之一的人口暴露在几乎没有实践变化的情况下，对死亡率没有显著影响。未来的研究应该集中在更短的真正高风险药物清单的管理上。
Objectives: To compare the prevalence of use of potentially inappropriate medicines (PIMs) between older patients living in their own homes versus those living in nursing or residential homes, and to test the association between exposure to PIMs and mortality.Design: Cohort study stratified by place of residence.Setting: Tayside, Scotland.Participants: All people aged between 66 and 99 years who were resident or died in Tayside from 2005 to 2006.Main outcome measures: The exposure variable was PIM use as defined by Beers' Criteria. All cause mortality was the main outcome measure.Results: 70 299 people were enrolled in the cohort of whom 96% were exposed to any medicine and 31% received a PIM. Place of residence was not associated with overall risk of receiving PIMs, adjusted OR 0.94, 95% CI 0.87 to 1.01. Exposure to five of the PIMs (including long-acting benzodiazepines) was significantly higher in nursing homes whereas exposure to five other PIMs (including amitriptyline and NSAIDs) was significantly lower. Exposure to PIMs was similar (20-46%) across all 71 general practices in Tayside and was not associated with increased risk of mortality after adjustment for age, gender and polypharmacy (adjusted OR 0.98, 95% CI 0.92 to 1.05).Conclusions: The authors question the validity of the full list of PIMs as an indicator of safety of medicines in older people because one-third of the population is exposed with little practice variation and no significant impact on mortality. Future studies should focus on management of a shorter list of genuinely high-risk medicines.