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中国全科医学 ›› 2021, Vol. 24 ›› Issue (25): 3161-3170.DOI: 10.12114/j.issn.1007-9572.2021.00.204

所属专题： 老年问题最新文章合集

• 专题研究 • 上一篇    下一篇

社区老年人多重用药率及其相关因素的系统综述

李荔1，李莎1，卫芸1，张园园1，闫丽娥2*   

  1. 1.100029北京市，中日友好医院北区神经科　2.100101北京市，中日友好医院西区护理部
    *通信作者：闫丽娥，主任护师；E-mail：yle730420@126.com
  • 出版日期:2021-09-05 发布日期:2021-09-05

Prevalence and Factors Associated with Polypharmacy in Community-dwelling Older People：a Systematic Review　

LI Li1，LI Sha1，WEI Yun1，ZHANG Yuanyuan1，YAN Li'e2*   

  1. 1.Department of Neurology，China-Japan Friendship Hospital（North），Beijing 100029，China
    2.Department of Nursing，China-Japan Friendship Hospital（West），Beijing 100101，China
    *Corresponding author：YAN Li'e，Chief superintendent nurse；E-mail：yle730420@126.com
  • Published:2021-09-05 Online:2021-09-05

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摘要： 背景　随着人群的老化和寿命的延长，需要药物治疗的老年人多病共存率明显增加，多重用药已经成为全球重要的公共卫生问题。目的　评价社区老年人多重用药率及其相关因素，为减少多重用药及危害、制定公共卫生政策提供依据。方法　检索Medline、Embase、Cochrane Library、中国知网和万方数据知识服务平台2000-01-01至2021-01-01发表的社区老年人多重用药现患率的相关中英文文献，并对纳入的研究进行质量评价与数据提取，使用RevMan 5.4软件进行Meta分析。结果　共纳入合格文献49篇。Meta分析结果显示，社区老年人多重用药率为37%〔95%CI（34%，39%）〕，过度多重用药率为14%〔95%CI（12%，16%）〕。有13篇文献进行了多重用药相关因素多变量分析，结果显示较多慢性病数量/多病共存（7篇），较年老者（6篇），超重/肥胖（5篇），自述健康不佳（4篇），日常生活能力受限（4篇），较低教育水平（4篇），自述患糖尿病（3篇），自述患高血压（2篇），自述患心脏病（2篇）等与多重用药呈正相关。结论　社区老年人多重用药高度流行，过度多重用药较为普遍。明确多重用药的相关因素对发现和监测老年人多重用药至关重要。在制定社区多重用药干预措施时，必须要考虑各种各样的多重用药相关因素，尤其是慢性病的预防和管理。医生和药师应基于循证处方，合理使用药物，从公共卫生角度而言，健康生活方式可能有助于减少慢性病和多重用药的发生。

关键词: 多重用药, 过度多重用药, 老年人, 社区卫生服务, 现患率, 系统综述

Abstract: Background　The number of older people needing pharmaceutical treatment due to multimorditiy is increasing along with population aging and the increase in longevity. Polypharmacy has become a major global public health problem. Objective　To assess the prevalence and factors associated with polypharmacy in community-dwelling older people，in order to provide evidence for reducing polypharmacy prevalence and medication-related harm as well as formulating public health interventions. Methods　We searched studies regarding prevalence of polypharmacy in community-dwelling older people published from 2000-01-01 to 2021-01-01 in English from databases of Medline，Embase and Cochrane Library，and those in Chinese from databases of CNKI and Wangfang Data. Data extraction and quality evaluation of the included studies were performed. RevMan 5.4 was used for meta-analysis. Results　Forty-nine studies met the inclusion criteria. Meta-analysis indicated that the pooled prevalence of polypharmacy and excessive polypharmacy in community-dwelling older people was 37% 〔95%CI（34%，39%）〕 and 14%〔95%CI（12%，16%）〕，respectively. 13 studies performed multivariate statistical analyses identifying independent variables associated with polypharmacy. Positive associations were found for multiple chronic diseases/ multimorditiy（n=7 studies），older age（n=6 studies），being overweight or obesity（n=5 studies），poor self-reported heath（n=4 studies），limitations in actitivities of daily living（n=4 studies），low education attainment（n=4 studies），self-reported diabetes （n=3 studies），self-reported hypertension（n=2 studies） and self-reported heart disease（n=2 studies）. Conclusion　Polypharmacy is highly prevalent and excessive polypharmacy is relatively common in community-dwelling older people. Identification of factors associated with polypharmacy is important for identifying and monitoring the elderly groups most vulnerable to this problem. Therefore，when formulating community interventions for polypharmacy，especially for chronic disease prevention and management，various associated factors of polypharmacy should be taken into account. Doctors and pharmacists should write evidence-based prescriptions to ensure rational use of medicines. Additionally，developing a healthy lifestyle may be a public health intervention contributing to the reduction of chronic disease and polypharmacy prevalence.

Key words: Polypharmacy, Excessive polypharmacy, Aged, Community health services, Prevalence, Systematic review

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