Evaluation of Potentially Inappropriate Medication in Elderly Patients with Multiple Medications

doi:10.12114/j.issn.1007-9572.2021.00.489

Abstract

Abstract: Background　China has entered an aging society，and the elderly patients are susceptible to multiple chronic diseases，resulting in the common problems in multidisciplinary clinic and multiple medications.A number of researches have shown that the incidence of potentially inappropriate medication（PIM） in elderly patients is relatively high.Therefore，selecting elderly patients with multiple medications to evaluate PIM is conducive to identifying the influencing factors of PIM in elderly patients，which will provide a basis for improving the level of rational medication in older adults.Objective　To evaluate PIM and its influencing factors in elderly patients with multiple medications in cardiovascular medicine department，so as to provide reference for clinical rational medication.Methods　From February to June 2019 a total of 394 medical records of the elderly inpatients from the First Affiliated Hospital of the USTC were collected to evaluate their PIM based on Beers criteria（2019 edition） and Criteria of Potentially Inappropriate Medication for Elderly People In China，and multivariate Logistic regression analysis was used to investigate the influencing factors of PIM in elderly patients with multiple medications in cardiovascular medicine department.Results　Totally 394 patients aged（74.1±6.2）were included，the average hospital stay length was （8.1±4.4）d，and the average number of the types of drug used were（6.8±1.8）.According to Beers criteria（2019 edition），there were 270 items of PIM in 199 patients（50.5%）.The drugs with a high frequency of PIM were proton pump inhibitors，benzodiazepines and amiodarone.14 cases of PIM related to disease or symptoms，37 cases caused by drugs which shoulbe used with caution among the elderly，12 cases of drug interactions which should have been avoided，22 cases of renal insufficiency which should have been avoided or reduced in dose were detected.Diltiazem was used in 12 patients with heart failure，spironolactone was used in 20 cases with creatinine clearance below 30 ml/min.According to the Criteria of potentially inappropriate medications for older adults in China，there were 320 items of PIM in 262 patients （66.5%）.The drugs with a high incidence of PIM were clopidogrel，Warfarin and amiodarone.Multivariate Logistic regression analysis showed that the common influencing factors of PIM based on Beers criteria are age and the type of medicine used（P<0.05）；the common influencing factor of PIM based on Criteria of potentially inappropriate medications for older adults in China is the type of medicine used（P<0.05）.Conclusion　The current situation of potentially inappropriate medication in elderly patients with multiple medications is not optimistic，and the level of rational medications in older adults needs to be improved，and the type of drug used is the influencing factor of PIM.It is suggested that the elderly patients should streamline administration.For the drugs which should be avoided in patients with certain diseases or pathological conditions，attention should be paid to drug interactions to reduce the damage of multiple drugs to elderly patients.

Key words: Polypharmacy, Aged, Cardiovascular medicine, Cardiovascular diseases, Multiple medications, Potentially inappropriate medication, Potentially inappropriate medication list, Beers criteria, Criteria of potentially inappropriate medications for older adults in China

摘要： 背景　我国已进入老龄化社会，由于老年人群易罹患多种慢性疾病，造成多科就诊、多重用药问题普遍，多项研究提示老年患者潜在不适当用药（PIM）发生率较高，因此选取老年多重用药患者进行PIM评价，有利于识别老年患者PIM的影响因素，以提高老年人合理用药水平。目的　探讨心血管内科老年多重用药患者PIM情况及其影响因素，为临床合理用药提供参考。方法　2019年2—6月收集中国科学技术大学附属第一医院老年住院患者病历394份，以Beers标准（2019版）及《中国老年人潜在不适当用药判断标准》为依据评价其PIM情况，并采用多因素Logistic回归分析探讨心血管内科老年多重用药患者发生PIM的影响因素。结果　共收集患者394例，平均年龄为（74.1±6.2）岁，平均住院天数为（8.1±4.4）d，平均用药种类为（6.8±1.8）种。依据Beers标准（2019版）共199例（50.5%）患者存在PIM 270例次，PIM发生率较高的药物为：质子泵抑制剂、苯二氮类和胺碘酮。与疾病或症状相关PIM 14例次、老年人慎用药物37例次、应避免的药物相互作用12例次、肾功能不全应避免或降低剂量的药物22例次。心力衰竭患者使用地尔硫12例，肌酐清除率低于30 ml/min患者使用螺内酯20例。依据《中国老年人潜在不适当用药判断标准》共262例患者（66.5%）存在PIM 320例次，PIM发生率较高的药物为氯吡格雷、华法林和胺碘酮。多因素Logistic回归分析结果显示，依据Beers标准（2019版），年龄、用药种类为PIM发生的影响因素（P<0.05）；依据《中国老年人潜在不适当用药判断标准》，用药种类为PIM发生的影响因素（P<0.05）。结论　老年多重用药患者PIM现状不容乐观，老年人合理用药水平有待提升，用药种类为PIM发生的影响因素。主张老年患者精简用药，针对某些疾病或病理状态下的患者应杜绝使用避免使用的药物，重视药物相互作用，以减少多重用药对老年患者的损害。

关键词: 多种药物疗法, 老年人, 心血管内科, 心血管疾病, 多重用药, 潜在不当用药清单, Beers标准, 中国老年人潜在不适当用药判断标准

SHU Bing,FANG Yuting,LI Min, et al. Evaluation of Potentially Inappropriate Medication in Elderly Patients with Multiple Medications　[J]. Chinese General Practice, 2021, 24(17): 2134-2139. DOI: 10.12114/j.issn.1007-9572.2021.00.489.
舒冰,方玉婷,李民等. 老年多重用药患者潜在不适当用药情况及其影响因素研究[J]. 中国全科医学, 2021, 24(17): 2134-2139. DOI: 10.12114/j.issn.1007-9572.2021.00.489.

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