Incident Use and Outcomes Associated With Potentially Inappropriate Medication Use in Older Adults
Incident Use and Outcomes Associated With Potentially Inappropriate Medication Use in Older Adults
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DOI：
10.1016/s1543-5946(10)80005-4
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发表时间：
2010-12-01
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影响因子：
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通讯作者：
Thomas, Joseph, III
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文献类型：
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作者：
Dedhiya, Seema D.;Hancock, Emily;Thomas, Joseph, III
背景资料：大多数关于老年人潜在不当用药（PIM）的研究都集中在患病率而不是发病率上。目的：本研究的目的是确定印第安纳州医疗补助计划中老年疗养院居民PIM使用的1年发病率，并研究PIM使用与住院和死亡率之间的关系。方法：使用印第安纳州医疗补助登记和行政索赔文件进行了回顾性分析。如果个人符合医疗补助条件，并且截至2003年1月年龄≥ 65岁，并且在2003年的每个月或直到2003年死亡之前接受疗养院服务，则将其纳入。个人也必须接受疗养院服务，从2002年10月至2002年12月列入样本。为了集中分析事件PIM使用，从2002年10月至2002年12月接受任何PIM处方药的个人被排除在样本之外，2003年没有处方任何新药的人也被排除在外。使用2003年Beers标准识别PIM。在控制其他危险因素后，使用逻辑回归模型评估事件PIM使用与住院和死亡率之间的关联。潜在的选择偏差进行了检查使用双变量probit models.Results：研究样本包括7594个人（平均年龄，83.07岁）。大多数样本为女性（76.5%）、白色（89.7%）和丧偶（58.8%）。大多数人在城市地区（5306 [69.9%]）和印第安纳州中部地区（2838 [37：4%]）的疗养院接受护理。PIM使用的一年发生率为42.1%。事故PIM用户更有可能住院治疗（比值比[OR] = 1.27; 95% CI，1.10-1.46）和更有可能死亡（OR = 1.46; 95%CI，1.31-1.62）在第一次接受PIM后的12个月内，即使在调整人口统计学和临床风险因素后，也是如此。在疗养院的这些印第安纳州医疗补助老年居民中，事件PIM的使用率很高。开始使用PIM的个人住院和死亡的风险更高。(Am老年药理学杂志。2010;8：562-570）（C）2010 Elsevier HS Journals，Inc.
Background: Most studies of potentially inappropriate medication (PIM) use among older adults have focused on prevalence rather than incidence.Objectives: The goals of this study were to determine the 1-year incidence of PIM use among elderly Indiana Medicaid residents of nursing homes and to examine associations between incident PIM use and hospitalization and mortality.Methods: A retrospective analysis was conducted using Indiana Medicaid enrollment and administrative claims files. Individuals were included if they were Medicaid eligible and aged >= 65 years as of January 2003 and received nursing home services in each month of 2003 or until death in 2003. Individuals also had to receive nursing home services from October 2002 through December 2002 for inclusion in the sample. To focus analysis on incident PIM use, individuals who received any PIM prescription medication from October 2002 through December 2002 were excluded from the sample, as were those not prescribed any new medication in 2003. PIMs were identified using the 2003 Beers criteria. Associations between incident PIM use and hospitalization and mortality were assessed using logistic regression models after controlling for other risk factors. Potential selection bias was examined using bivariate probit models.Results: The study sample consisted of 7594 individuals (mean age, 83.07 years). A majority of the sample was female (76.5%), white (89.7%), and widowed (58.8%). Most individuals received care in nursing homes located in urban areas (5306 [69.9%]) and in the central region of Indiana (2838 [37:4%]). One-year incidence of PIM use was 42.1%. Incident PIM users were more likely to be hospitalized (odds ratio [OR] = 1.27; 95% CI, 1.10-1.46) and more likely to die (OR = 1.46; 95% CI, 1.31-1.62) in the 12 months after first receiving a PIM than non-users, even after adjusting for demographic and clinical risk factors.Conclusions: Incident PIM use was high among these elderly Indiana Medicaid residents of nursing homes. Individuals who began use of a PIM were at a higher risk of hospitalization and of dying. (Am J Geriatr Pharmacother. 2010;8:562-570) (C) 2010 Elsevier HS Journals, Inc.