Objective To measure the prevalence and risk factors of potentially inappropriate medication (PIM) use among elderly inpatients by using the Chinese PIM list and 2015 Beers criteria. Methods The data of patients ≥65 years of age and hospitalized in Department of Internal Medicine in the Third People’s Hospital of Hefei from January to June in 2017 were collected and the gender, age, department, diseases that patients suffered from, hospitalization days, drug varieties used in one patient, methods of payment were recorded.The situation of PIM was analyzed according to the Chinese PIM list (Chinese list, including 72 drugs) and 2015 Beers criteria (PIM associated with age, including 62 drugs) and the risk factors of PIM use were analyzed by logistic regression. Results A total of 431 patients were enrolled, including 236 males and 195 females.Of the 431 patients, 284(65.9%)patients were 65-<80 years old and 147(34.1%)were ≥80 years old.According to the Chinese list and 2015 Beers criteria, 52.7%(227/431)and 24.6%(106/431) of patients were prescribed one PIM drug(χ2=63.120, P=0.000).The results of Logistic regression showed that the main risk factors of PIM use were ages[OR=0.700,95%CI(1.292,3.139),P=0.002] and varieties of prescribed drugs [OR=1.295,95%CI(2.561,5.208),P=0.000] by using the Chinese list, and number of diseases that patients suffered from[OR=0.334,95%CI(0.989,1.972),P=0.048] and varieties of prescribed drugs [OR=0.865,95%CI(1.663,3.392),P=0.000] by using 2015 Beers criteria. Conclusion According to the Chinese PIM list, the prevalence of PIM use in elderly inpatients in our hospital is higher.The risk factors of PIM use are patients’ age, number of diseases that patient suffered from and varieties of drugs according to the Chinese PIM list and 2015 Beers criteria.
Key words:
Potentially inappropriate medication list
;
Beers criteria
;
Inpatient
;
elderly
;
Number of diseases
;
Vorieties of drugs
表4
老年住院患者PIM的危险因素与赋值
Tab.4
Risk factors and codes of PIM in elderly inpatients
因素
变量名
赋值说明
年龄/岁
X1
65~80=1,≥80=2
性别
X2
男=1,女=2
患病种数
X3
1~3=1,4~7=2,≥8=3
用药种数
X4
≤8=1,9~15=2,≥16=3
住院时间/d
X5
≤8=1,9~19=2,≥20=3
付费方式
X6
职工或居民医保=1,退休或离休医保=2,新
农合=3,自费及其他=4
使用PIM药物
Y
存在=1,不存在=0
表4
老年住院患者PIM的危险因素与赋值
Tab.4
Risk factors and codes of PIM in elderly inpatients
表5
Tab.5
表5
表5
依据中国老年人PIM目录老年住院患者PIM影响因素的Logistic回归分析
Tab.5
Multivariate logistic regression analysis on risk factors of PIM in elderly patients according to Chinese PIM list
因素
回归系数
标准误
Wald值
P值
OR值
95%CI
年龄
0.700
0.226
9.554
0.002
2.014
(1.292,3.139)
用药种数
1.295
0.181
51.178
0.000
3.652
(2.561,5.208)
表5
依据中国老年人PIM目录老年住院患者PIM影响因素的Logistic回归分析
Tab.5
Multivariate logistic regression analysis on risk factors of PIM in elderly patients according to Chinese PIM list
表6
Tab.6
表6
表6
依据2015年版Beers标准老年住院患者PIM影响因素的Logistic回归分析
Tab.6
Multivariate logistic regression analysis on risk factors of PIM in elderly patients according to 2015 Beers criteria
因素
回归系数
标准误
Wald值
P值
OR值
95%CI
患病种数
0.334
0.176
3.595
0.048
1.396
(0.989,1.972)
用药种数
0.865
0.182
22.654
0.000
2.375
(1.663,3.392)
表6
依据2015年版Beers标准老年住院患者PIM影响因素的Logistic回归分析
Tab.6
Multivariate logistic regression analysis on risk factors of PIM in elderly patients according to 2015 Beers criteria
BEERS MH.Explicit criteria for determining potentially inappropriate medication use by the elderly:an update[J].Arch Intern Med,1997,157(14):1531-1536.
[本文引用:1]
[3]
FICK DM,COOPER JW,WADE WE,et al.Updating the Beers criteria for potentially inappropriate medication use in older adults:results of a US consensus panel of experts[J].Arch Intern Med,2003,163(22):2716-2724.
[本文引用:2]
[4]
The American Geriatrics Society,2012 Beers Criteria Update Expert Panel.American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults[J].J Am Geriatr Soc,2012,60(4):616-631.
Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modified Delphi method to the systematic review and grading to reach consensus on the updated 2012 AGS Beers Criteria. Fifty-three medications or medication classes encompass the final updated Criteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria. Thoughtful application of the Criteria will allow for (a) closer monitoring of drug use, (b) application of real-time e-prescribing and interventions to decrease ADEs in older adults, and (c) better patient outcomes.
ObjectiveTo develop a list of potentially inappropriate medication (PIM) for the Chinese aged people and provide reference for prevention and reduce the medication risk of the aged people.MethodsBased on the PIM lists of the United States, Canada, Japan, France, Norway, Germany, South Korea and Austria, and combined with the data of serious adverse drug reactions (ADR) in the aged people collected from China National Center for ADR Monitoring, ADR monitoring center in the People Liberation Army, Beijing Center for ADR Monitoring and ADR data from Beijing 22 hospitals, we created a preliminary PIM list for the Chinese aged people. Using Delphi technique experts consultation was made for the initial list. Round 1 consultantation invited 32 experts, according to the expert advice to adjust the initial list, and form a revised list. Round 2 consultantation invited 38 experts, according to the expert advice to adjust revised list, and the final version of the PIM list formed. ResultsA total of 13-class 72 medications or medication classes were selected as the Chinese aged people PIM list, each medicine had 1-6 risk points. The list was divided according to the result of expert evaluation into 35 kinds of high risk medications and 37 kinds of low risk medications. In addition, according to the frequency of drug use, the medications were divided into A and B two categories, including 24 medications or medication classes as the preferred alert medications (A), 48 medications or medication classes as routinely alert medications (B).ConclusionPIM list for the Chinese aged people have been developed, which can be taken as reference to intervention and evaluation of China elderly medication.
FDA.FDA Drug Safety Communication:FDA reviews long-term antiplatelet therapy as preliminary trial data shows benefits but a higher risk of non-cardiovascular death [EB/ OL].(2014-11-16)[2017-7-18]..
LIM,DINGD,PU SY,et al.Patients aged 80 years or older are encountered more potentially inappropriate medication use[J].Chin Med J,2016,129(1):22-27.
Polypharmacy and potentially inappropriate medications (PIMs) are prominent prescribing issues in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatients between 65–79 years of age and 80 years or older, who were discharged from Geriatric Department in West China Hospital. A large-scale cohort of 1796 inpatients aged 65 years or over was recruited. Respectively, 618 patients were 65–79 years and 1178 patients were 80 years or older. Updated 2012 Beers Criteria by the American Geriatric Society was applied to assess the use of PIM among the investigated samples. A review of the prescribed medications identified 686 patients aged 80 years or older consumed at least one PIM giving a rate of 58.2%. Conversely, 268 (43.4%) patients aged 65–79 years consumed at least one PIM (χ2= 40.18,P< 0.001). Patients aged 80 years or older had higher hospitalization expenses, length of stay, co-morbidities, medical prescription, and mortality than patients aged 65–79 years (all withP< 0.001). Patients aged 80 years or older were prescribed with more benzodiazepines, drugs with strong anticholinergic properties, megestrol, antipsychotics, theophylline, and aspirin. In multiple regression analysis, PIM use was significantly associated with female gender, age, number of diagnostic disease, and number of prescribed medication. The finding from this study revealed that inpatients aged 80 years or older encountered more PIM use than those aged 65–79 years. Anticholinergic properties, megestrol, antipsychotics, theophylline, and aspirin are medications that often prescribed to inpatients aged 80 years or older. Doctors should carefully choose drugs for the elderly, especially the elderly aged 80 years or older.
FDA Drug Safety Communication:FDA reviews long-term antiplatelet therapy as preliminary trial data shows benefits but a higher risk of non-cardiovascular death
, 张国柱
