Geriatric conditions, medication use, and risk of adverse drug events in a predominantly male, older veteran population.
Geriatric conditions, medication use, and risk of adverse drug events in a predominantly male, older veteran population.
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以男性为主的老年退伍军人群体的老年状况、药物使用和药物不良事件的风险。
DOI：
10.1111/j.1532-5415.2011.03331.x
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发表时间：
2011
影响因子：
6.3
通讯作者：
Kaboli,PeterJ
中科院分区：
文献类型：
--
作者：
Steinman,MichaelA;Lund,BrianC;Miao,Yinghui;Boscardin,WJohn;Kaboli,PeterJ
目的：确定老年状况和功能障碍是否是药物不良事件（ADEs）的独立危险因素。设计：前瞻性队列研究。地点：退伍军人事务医疗中心。参与者：377名年龄在65岁以上且服用5种或更多药物的退伍军人。测量方法：通过参与者访谈和研究基线的结构化评估来评估老年状况和功能状态。在研究入组后3个月和12个月的参与者访谈中，使用经过验证的方法得出ade。结果：绝大多数（97%）参与者为男性，平均年龄为74±5岁；123例（33%）在日常生活工具活动（IADLs）中有一种或多种依赖。在1年的研究期间，126名参与者（33%）发生了167次ade。通过多变量分析，ADEs的风险与任何有足够能力评估的老年疾病无关，包括IADL功能、认知障碍、抑郁、视力障碍、大小便失禁、便秘，以及包括上述和跌倒或步态不稳定史的老年负担总结性测量。在探索性分析中，与ade相关的最强因素是参与者在1年研究期间增加的药物数量（每增加一种药物的发生率比为1.11,95%可信区间= 1.03-1.19）。结论：在以男性为主的老年退伍军人人群中，常见的老年疾病和IADL功能与ADEs无关。虽然考虑每个参与者的独特情况是很重要的，但在给患有这些老年疾病的老年人开处方时过度谨慎可能是不必要的。
OBJECTIVES:To determine whether geriatric conditions and functional impairment are independent risk factors for adverse drug events (ADEs).DESIGN:Prospective cohort study.SETTING:Veterans Affairs Medical Center.PARTICIPANTS:Three hundred seventy‐seven veterans aged 65 and older and taking five or more medications.MEASUREMENTS:Geriatric conditions and functional status were assessed using participant interviews and structured assessments at study baseline. ADEs were elicited during participant interviews 3 and 12 months after study enrollment using validated methods.RESULTS:The strong majority (97%) of participants were male, with a mean age of 74±5; 123 (33%) had one or more dependencies in instrumental activities of daily living (IADLs). Over the 1‐year study period, 126 participants (33%) developed 167 ADEs. Upon multivariable analysis, risk of ADEs was not associated with any of the geriatric conditions that there was sufficient power to evaluate, including IADL function, cognitive impairment, depression, visual impairment, incontinence, constipation, and a summative measure of geriatric burden comprising the above and history of falls or gait instability. In exploratory analyses, the strongest factor associated with ADEs was the number of drugs added to a participant's medication regimen during the 1‐year study period (incidence rate ratio 1.11 per each added drug, 95% confidence interval=1.03–1.19).CONCLUSION:Common geriatric conditions and IADL function were not associated with ADEs in a predominantly male, older veteran population. Although it is important to consider the unique circumstances of each participant, excessive caution in prescribing to older adults with these geriatric conditions may not be warranted.