老年人多重用药依从性现状及影响因素的Meta分析  

Current Status of Polypharmacy in the Elderly and Its Influencing Factors:a Meta-analysis

作　　者：谢雪梅 高静[1] 柏丁兮[1] 卢贤英 何佳丽 李月 XIE Xuemei;GAO Jing;BAI Dingxi;LU Xianying;HE Jiali;LI Yue(School of Nursing,Chengdu University of Traditional Chinese Medicine,Chengdu 611137,China)

机构地区：[1]成都中医药大学护理学院,四川省成都市611137

出　　处：《中国全科医学》2023年第35期4394-4403,共10页Chinese General Practice

基　　金：四川省社科规划项目(SC22B150)。

摘　　要：背景老年人多重用药现象已日益普遍。而多重用药依从性与其治疗效果及安全性密切相关,故早期了解老年人多重用药依从性及其影响因素具有重要意义。但目前研究结论差异较大,尚无明确统一的标准。目的系统评价老年人多重用药依从性现状及其影响因素,为后期提高老年人多重用药依从性,减少不良反应,进一步制订个性化干预方案提供参考。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、Scopus、Ovid、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网中有关老年人多重用药(年龄≥60岁,用药种类≥5种)依从性影响因素的队列研究、病例对照研究、横断面研究等观察性研究,检索时限为建库至2023年3月。由2名研究者按照纳入与排除标准独立进行文献筛选、质量评价以及资料提取。采用Stata 17.0和RevMan 5.3软件进行Meta分析。结果共纳入19篇文献,总样本量为130047例,其中服药依从性好的人数为50852例。Meta分析结果显示,老年人多重用药的服药依从率为41%〔95%CI(34%,47%)〕,多重用药依从性与年龄〔OR=2.62,95%CI(1.60,4.78),P<0.0001〕、性别〔OR=1.70,95%CI(1.30,2.23),P=0.0001〕、文化程度〔OR=1.73,95%CI(1.38,2.16),P<0.00001〕、居住方式〔OR=2.85,95%CI(2.18,3.72),P<0.00001〕、用药知识水平〔OR=1.14,95%CI(1.04,1.25),P=0.005〕、服药信念〔OR=2.06,95%CI(1.44,2.93),P<0.0001〕、抑郁〔OR=2.52,95%CI(1.96,3.24),P<0.00001〕、日常生活能力(ADL)〔OR=2.39,95%CI(1.68,3.38),P<0.00001〕、跌倒史〔OR=3.51,95%CI(2.03,6.06),P<0.00001〕、专业人员指导〔OR=3.75,95%CI(1.92,7.33),P=0.0001〕、用药种类数量〔OR=2.58,95%CI(1.96,3.41),P<0.0001〕、药物不良反应〔OR=3.08,95%CI(2.17,4.38),P<0.0001〕、用药方案复杂性〔OR=1.08,95%CI(1.03,1.14),P=0.004〕、药物管理〔OR=1.92,95%CI(1.34,2.75),P=0.0003〕、用药费用〔OR=2.60,95%CI(1.30,5.17),P=0.0007〕有关。Background Polypharmacy is increasingly common in the elderly.The medication compliance of polypharmacy is closely related to its therapeutic effect and safety.Therefore,it is of great significance to understand the medication compliance and its influencing factors in the elderly with polypharmacy at early stage.However,the conclusions of current studies vary greatly,and there is no clear and unified standard.Objective To systematically evaluate the current status of polypharmacy in the elderly and its influencing factors,in order to provide reference for improving medication compliance of polypharmacy in the elderly,reducing adverse reactions,and further developing individualized intervention programs.Methods PubMed,Embase,Web of Science,Cochrane Library,Scopus,Ovid,CBM,CNKI,Wanfang Data and VIP were searched for cohort studies,case-control studies,cross-sectional studies and other observational studies on the influencing factors of medication compliance of polypharmacy in the elderly from inception to March 2023.Two researchers independently screened the literature,evaluated the quality and extracted the data according to the inclusion and exclusion criteria.Stata 17.0 and RevMan 5.3 software were used for meta-analysis.Results A total of 19 studies were included with the total sample size of 130047 subjects,including 50852 subjects with good medication compliance.Meta-analysis results showed that the medication compliance rate of polypharmacy in the elderly was 41%〔95%CI(34%,47%)〕,which was associated with age〔OR=2.62,95%CI(1.60,4.78),P<0.0001〕,gender〔OR=1.70,95%CI(1.30,2.23),P=0.0001〕,education level〔OR=1.73,95%CI(1.38,2.16),P<0.00001〕,residential lifestyle〔OR=2.85,95%CI(2.18,3.72),P<0.00001〕,medication knowledge level〔OR=1.14,95%CI(1.04,1.25),P=0.005〕,medication belief〔OR=2.06,95%CI(1.44,2.93),P<0.0001〕,depression〔OR=2.52,95%CI(1.96,3.24),P<0.00001〕,daily living ability(ADL)〔OR=2.39,95%CI(1.68,3.38),P<0.00001〕,history of falls〔OR=3.51,95%CI(2.03,6.06),P<0.00001〕,profes

关 键 词：多重用药 老年人 服药依从性 影响因素分析 META分析 

分 类 号：R161.7[医药卫生—公共卫生与预防医学]