Deprescribing in Frail Older People: A Randomised Controlled Trial
Deprescribing in Frail Older People: A Randomised Controlled Trial
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DOI：
10.1371/journal.pone.0149984
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发表时间：
2016-03-04
期刊：
影响因子：
3.7
通讯作者：
Etherton-Beer, Christopher
中科院分区：
文献类型：
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作者：
Potter, Kathleen;Flicker, Leon;Etherton-Beer, Christopher
目的已被提出作为一种方法，以减少多药在体弱的老年人。我们的目标是减少居住在老年护理设施（RACF）中的人的药物消耗量。次要目标是探讨的影响，取消对生存，福尔斯，骨折，住院，认知，身体，和肠道功能，生活质量，和sleep. MethodsNine 5人年龄超过65岁，生活在四个RACF在西澳大利亚中西部农村随机在一项开放性研究。干预组（n = 47）接受了取消处方干预，即计划停用非有益药物。对照组48例，给予常规护理。从随机化开始，对参与者进行为期12个月的监测。主要结果是独特的常规药物的平均数量的变化。所有结果进行了评估，在基线，6，和12个months.ResultsStudy参与者的平均年龄为84.3 +/- 6.9岁，52%是女性。干预组参与者在基线时消耗9.6 +/- 5.0，对照组参与者消耗9.5 +/- 3.6独特的常规药物。在348种拟取消处方的药物（每人7.4 +/- 3.8，占常规药物的78%）中，207种药物（每人4.4 +/- 3.4，占目标药物的59%）已成功停用。干预组参与者12个月时常规药物数量的平均变化为-1.9 +/- 4.1，对照组参与者为+0.1 +/- 3.5（估计差异为2.0 +/- 0.9，95% CI 0.08，3.8，p = 0.04）。12名干预参与者和19名对照参与者在随机化后12个月内死亡（死亡率分别为26%和40%，p = 0.16，HR 0.60，95% CI 0.30 - 1.22），其他次要结局组间无显著差异。本研究的主要局限性是开放式设计和小参与者numbers. ConclusionsDepriving的数量减少了经常服用的药物的体弱老年人居住在住宅护理的生存或其他临床结果没有显着的不良影响。
ObjectivesDeprescribing has been proposed as a way to reduce polypharmacy in frail older people. We aimed to reduce the number of medicines consumed by people living in residential aged care facilities (RACF). Secondary objectives were to explore the effect of deprescribing on survival, falls, fractures, hospital admissions, cognitive, physical, and bowel function, quality of life, and sleep.MethodsNinety-five people aged over 65 years living in four RACF in rural mid-west Western Australia were randomised in an open study. The intervention group (n = 47) received a deprescribing intervention, the planned cessation of non-beneficial medicines. The control group (n = 48) received usual care. Participants were monitored for twelve months from randomisation. Primary outcome was change in the mean number of unique regular medicines. All outcomes were assessed at baseline, six, and twelve months.ResultsStudy participants had a mean age of 84.3 +/- 6.9 years and 52% were female. Intervention group participants consumed 9.6 +/- 5.0 and control group participants consumed 9.5 +/- 3.6 unique regular medicines at baseline. Of the 348 medicines targeted for deprescribing (7.4 +/- 3.8 per person, 78% of regular medicines), 207 medicines (4.4 +/- 3.4 per person, 59% of targeted medicines) were successfully discontinued. The mean change in number of regular medicines at 12 months was -1.9 +/- 4.1 in intervention group participants and +0.1 +/- 3.5 in control group participants (estimated difference 2.0 +/- 0.9, 95% CI 0.08, 3.8, p = 0.04). Twelve intervention participants and 19 control participants died within 12 months of randomisation (26% versus 40% mortality, p = 0.16, HR 0.60, 95% CI 0.30 to 1.22) There were no significant differences between groups in other secondary outcomes. The main limitations of this study were the open design and small participant numbers.ConclusionsDeprescribing reduced the number of regular medicines consumed by frail older people living in residential care with no significant adverse effects on survival or other clinical outcomes.