社区老年人潜在不适当用药与衰弱的相关性  

Correlation of potentially inappropriate medication and frailty in community-dwelling elderly

作　　者：单青 胡波[1] 陈孟莉[2] SHAN Qing;HU Bo;CHEN Meng-Li(Postgraduate School,Chinese PLA General Hospital,Beijing 100853,China;Department of Pharmacy,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院研究生院,北京100853 [2]中国人民解放军总医院药剂科,北京100853

出　　处：《中华老年多器官疾病杂志》2021年第8期581-585,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：军队保健专项科研课题(18BJZ23)。

摘　　要：目的使用中国标准筛查社区老年患者潜在不适当用药(PIM),并研究PIM、神经系统PIM与衰弱的相关性。方法招募2018年12月至2019年3月北京某社区的老年人,记录其一般情况、患病情况及用药情况。使用埃德蒙德衰弱量表评估衰弱情况。根据《中国老年人潜在不适当用药目录》筛查PIM。根据查尔森共病指数判断共病严重情况。采用SPSS 24.0软件进行数据分析。按照数据类型不同,组间比较采用t检验、非参数秩和检验及卡方检验。使用logistic回归分析PIM与衰弱、神经系统PIM与衰弱之间的关联。结果最终纳入老年患者562例,年龄65~97岁,男性188例(33.4%)。年龄中位数为85(82,88)岁。PIM使用率为69.6%(391/562),PIM使用在年龄、性别、照护情况、收入、药物数量、多重用药、查尔森共病指数评分(CCI)以及衰弱评分中差异有统计学意义(P<0.05)。其中神经系统PIM使用率为23.8%(134/562),最常用的5种神经系统PIM为艾司唑仑、唑吡坦、地西泮、尼麦角林及劳拉西泮。314例(55.9%)老年人衰弱,重度衰弱老年人为32例(5.7%)。衰弱程度与高龄、CCI、多重用药以及PIM使用差异有统计学意义(P<0.001)。多因素分析表明,神经系统PIM与衰弱显著,且独立相关(OR=1.597,95%CI 1.051~2.428)。结论社区老年人PIM使用率较高,且衰弱人数多。神经系统PIM与衰弱有显著且独立相关性。Objective To screen potentially inappropriate medication(PIM)in the community-dwelling elderly with Chinese criteria and investigate the correlation of PIM,especially nervous system PIM with frailty.Methods Elderly people was recruited from a community in Beijing from December 2018 to March 2019.Their general condition,illness and medications were recorded.Edmonton frailty scale(EFS)was used to assess frailty and its level.PIM were evaluated according to the Lists of PIM for older adults in China,a country-specific Chinese PIM criteria.The severity of comorbidities was assessed according to the Charlson comorbidity index(CCI).SPSS statistics 24.0 was used to perform the statistical analysis.The measure data were expressed as mean±standard deviation(±s),and enumerate data were expressed as percentage(%).Data comparison between two groups was perfomed using t test,nonparametric test orχtest depending on date type.Logistic regression analysis was employed to analyze the relationships between PIM and frailty,and between nervous system PIM and frailty.Results A total of 562 elderly patients were finally enrolled in this study.They were 65 to 97 years old,with a median age of 85(82,88)years,and the males accounted for 33.4%(188/562).The prevalence of PIM was 69.6%(391/562).PIM differed in age,gender,care situation,income,number of drugs,polypharmacy,CCI and EFS scores(P<0.05).The use rate of nervous system PIM was 23.8%(134/562).The 5 most commonly used nervous system PIMs were estazolam,zolpidem,diazepam,nicergoline and lorazepam.Among the 314 frail elderly patients(55.9%),32(5.7%)suffered from severe frailty.Logistic regression analysis showed that the level of frailty was significantly different from advanced age,CCI score,polypharmacy,and the number of PIM used(P<0.001).Multivariate analyses showed that nervous system PIM was significantly and independently correlated with frailty(OR=1.597,95%CI 1.051-2.428).Conclusion The prevalence of PIM is relatively high among the elderly in the community,and many of

关 键 词：老年人 多重用药 潜在不适当用药 衰弱 共病 

分 类 号：R592[医药卫生—老年医学] R917[医药卫生—内科学]