Polypharmacy in people with dementia: Associations with adverse health outcomes
Polypharmacy in people with dementia: Associations with adverse health outcomes
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DOI：
10.1016/j.exger.2018.02.011
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发表时间：
2018-06-01
影响因子：
3.9
通讯作者：
Stewart, Robert
中科院分区：
文献类型：
--
作者：
Mueller, Christoph;Molokhia, Mariam;Stewart, Robert
在社区样本中，多重用药与较高的住院和死亡风险有关。它通常存在于痴呆症患者中，但很少在该人群中研究这些风险。我们的目的是调查多种药物治疗与急诊科就诊、任何计划外住院以及痴呆症患者死亡率之间的关系。利用伦敦南部的一个大型心理健康保健数据库，与住院和死亡率数据相关联，我们收集了一组被诊断为痴呆症的患者的回顾性队列。我们确定了痴呆症诊断时所开药物的数量，并进行了多变量 Cox 回归分析。在确定的 4668 名痴呆症患者中，有 1128 名患者 (24.2%) 服用了 4-6 种药物，739 名患者 (15.8%) 服用了 7 种以上药物。与使用 0-3 种药物的患者相比，使用 4-6 种或 >= 7 种药物的痴呆患者在控制潜在混杂因素后，急诊就诊（风险比 1.20/1.35）、住院（风险比 1.12/1.32）、计划外入院（风险比 1.12/1.25）和两年内死亡（风险比 1.29/1.39）的风险增加。我们发现有证据表明，基线时每种额外药物的剂量反应关系都会使急诊就诊和死亡率增加 5%，住院治疗风险增加 3%。总之，痴呆症诊断时的多重用药与不良健康结果的风险较高相关。未来的研究需要阐明哪些特定药物构成了这种关系，以及减少不当处方是否能有效预防痴呆症的这些结果。
Polypharmacy has been linked to higher risks of hospitalisation and death in community samples. It is commonly present in people with dementia but these risks have rarely been studied in this population. We aimed to investigate associations between polypharmacy and emergency department attendance, any and unplanned hospitalisation, and mortality in patients with dementia. Using a large mental health care database in South London, linked to hospitalisation and mortality data, we assembled a retrospective cohort of patients diagnosed with dementia. We ascertained number of medications prescribed at the time of dementia diagnosis and conducted multivariate Cox regression analyses. Of 4668 patients with dementia identified, 1128 (24.2%) were prescribed 4-6 medications and 739 (15.8%) >= 7 medications. Compared to those using 0-3 medications, patients with dementia using 4-6 or >= 7 agents had an increased risk of emergency department attendance (hazard ratio 1.20/1.35), hospitalisation (hazard ratio 1.12/1.32), unplanned hospital admission (hazard ratio 1.12/1.25), and death within two years (hazard ratio 1.29/1.39) after controlling for potential confounders. We found evidence of a dose response relationship with each additional drug at baseline increasing the risk of emergency department attendance and mortality by 5% and hospitalisation by 3%. In conclusion, polypharmacy at dementia diagnosis is associated with a higher risk of adverse health outcomes. Future research is required to elucidate which specific agents underlie this relationship and if reduction of inappropriate prescribing is effective in preventing these outcomes in dementia.