Reduction of Polypharmacy in the Elderly
Reduction of Polypharmacy in the Elderly
复制标题
减少老年人同时服用多种药物
作者：
V. Rollason;N. Vogt
老年人的多药联用使治疗复杂化，增加了成本，对医疗保健机构来说是一个挑战。在药剂师角色不断演变的背景下，这项系统的审查审查了由药剂师领导的干预措施在减少多元药物方面的有效性。使用Medline、Embase老年病学和老年学(2001版)、Cochrane图书馆和国际药物摘要(IPA)数据库进行了计算机检索。还对关于多种药物和药剂师在老年人治疗中的作用的文章进行了手工搜索，并对所有检索到的文章的参考部分进行了搜索。使用的搜索词为“多药房”、“老年”、“老年”、“干预”和“药剂师(S)”。符合以下标准的文章被纳入：只有老年人被纳入研究，或者所有年龄段的人都被纳入研究，但研究给出了针对老年人的单独结果；结果表现为药物数量的减少；一名药剂师参与了研究；研究是对照或随机对照研究。我们最初确定了106篇文章，但只有14项研究符合我们的四个纳入标准。减少用药次数并不是大多数选定研究的主要目的，而往往是次要的结果。目标不同，总体目标是提高老年患者的处方质量。这些对照研究支持药剂师干预的有效性，尽管取消的药物数量很少。大多数研究的目的不是为了证明减少药物数量对多药联用的临床后果(不依从性、药物不良反应、药物-药物相互作用、住院风险增加和用药错误)的影响。最常报道的结果与成本节约有关。因此，很难评估干预措施是否对患者有利。许多已确定的研究的方法学质量很差。特别是，研究目标往往非常宽泛和模糊。多药联用本身有不同的定义，根据患者群体和研究环境的不同，适当的定义可能会有所不同。需要进一步研究，以找到减少多药联用的最有效方法，特别是在虚弱的老年人口中，并量化简化药物方案在改善生活质量方面的真正优势。
Polypharmacy in the elderly complicates therapy, increases cost, and is a challenge for healthcare agencies. In the context of the evolving role of the pharmacist, this systematic review examines the effectiveness of interventions led by pharmacists in reducing polypharmacy.A computerised search was conducted using Medline, Embase geriatrics and gerontology (2001 edition), the Cochrane Library and International Pharmaceutical Abstracts (IPA) databases. A manual search of articles on polypharmacy and the role of pharmacists in the therapy of the elderly and of the reference sections of all retrieved articles was also carried out. Search terms used were ‘polypharmacy’, ‘elderly’, ‘aged’, ‘intervention’ and ‘pharmacist(s)’. Articles that fulfilled the following criteria were included: only elderly people were included in the study, or all ages were included but the study gave separate results for the elderly; the outcome was expressed as a reduction in the number of medications; a pharmacist participated in the study; and the study was a controlled or a randomised controlled study.We initially identified 106 articles, but only 14 studies met our four inclusion criteria. Reduction in the number of medications was not the major purpose of most selected studies but often a secondary outcome. Objectives differed, the general aim being to enhance the quality of prescribing in elderly patients. These controlled studies argued in favour of the effectiveness of pharmacists’ interventions, even though the number of medications eliminated was small. Most studies were not designed to demonstrate the impact of reducing the number of drugs on the clinical consequences of polypharmacy (nonadherence, adverse drug reactions, drug-drug interactions, increased risk of hospitalisation, and medication errors).The most frequently reported outcome related to cost savings. It was therefore difficult to assess whether the interventions benefited the patient. The methodological quality of many identified studies was poor. In particular, the study objectives were often very broad and ill-defined. Polypharmacy itself has been defined in different ways and the appropriate definition may differ according to the patient population and the study setting.Further studies are needed to find the most effective way to reduce polypharmacy, especially in the frail elderly population, and to quantify the real advantages of simplifying their drug regimens in terms of improved quality of life.