潜在不适当药物对老年人不良临床结果的影响：一项回顾性队列研究

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy Pub Date : 2025-04-25 DOI:10.1016/j.rcsop.2025.100610

Irene Boateng , Carlos Rodriguez Pascual , Paul Grassby , Zahid Asghar

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引用次数: 0

摘要

目的探讨潜在不适宜用药（PIMs）与死亡率、住院率、药物不良反应和跌倒的关系，以及与预后相关的特异性不适宜用药。方法从临床实践研究数据链中选取1000例75岁及以上的患者进行回顾性队列研究。使用老年人处方筛选工具估计pim。使用logistic回归分析确定pim与死亡率、跌倒、药物不良反应或住院之间的关联。通过纳入不同类型pim与年龄、性别和发病率之间的相互作用项进行亚组分析。主要发现对1000人的数据进行了分析。36%为男性，平均年龄83岁。PIMs与结局相关的校正比值比（95%可信区间）为：死亡率1.03(0.92 - 1.14)，住院率1.21(1.04 - 1.40)，下降率1.30(1.12 - 1.51)，药物不良反应1.20（1.02 - 1.40）。PIMs对预后的影响在男性和≥86岁的人群中较高，并且随着PIMs数量的增加而增加。三环抗抑郁药、每日剂量≥200mg的单质铁、苯二氮卓类药物、神经抑制剂和长效阿片类药物与至少一种结果相关。结论潜在不当用药与住院、跌倒和药物不良反应相关，但与死亡无关。

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The impact of potentially inappropriate medicines on adverse clinical outcomes in the aged: A retrospective cohort study

Objectives

To determine the association between potentially inappropriate medicines (PIMs) and mortality, hospitalization, adverse drug reactions and falls and specific inappropriate medicines which are associated with the outcomes.

Methods

A retrospective cohort study was carried out using 1000 patients aged 75 years and above from the Clinical Practice Research Datalink. PIMs were estimated using the Screening Tool of Older People's Prescriptions. The association between PIMs and mortality, falls, adverse drug reactions, or hospitalization was determined using logistic regression analysis. Subgroup analyses were carried out by including an interaction term between different categories of PIMs and age, gender, and morbidity.

Key findings

Data of 1000 people were analysed. 36 % were male and the mean age was 83 years. Adjusted odds ratios with their 95 % confidence intervals for association between PIMs and outcomes were: mortality 1.03(0.92 to 1.14), hospitalization 1.21(1.04 to 1.40), falls 1.30(1.12 to 1.51) and adverse drug reactions 1.20(1.02 to 1.40). The effect of PIMs on the outcomes was high in men and ≥ 86 years old and increased with an increasing number of PIMs. Tricyclic antidepressants, elemental iron in doses ≥200 mg daily, benzodiazepines, neuroleptics and long-acting opioids were associated with at least one of the outcomes.