老年住院患者潜在不适当用药与共病、衰弱、失能的相关性

Association between potentially inappropriate medication and comorbidity, frailty and disability in the hospitalized elderly patients

摘要:

目的 探讨老年住院患者潜在不适当用药(PIM)与共病、衰弱、失能的关系。方法 入选2016年6月至2017年6月首都医科大学附属复兴医院综合科≥65岁老年住院患者372例,根据中国老年人PIM目录(2017 版)确定是否存在PIM,分为PIM组238例和非PIM组134例,记录患者一般情况、共病、查尔森共病指数(CCI)、衰弱和失能情况。应用SPSS 23.0统计软件对数据进行处理。组间比较采用独立样本t检验、非参数检验或χ²检验。Spearman相关分析PIM与患者共病、衰弱、失能的相关性。多因素logistic回归分析PIM的相关危险因素。结果 372例患者PIM发生率64.0%(238/372)。PIM药物前3位分别为氯吡格雷27.2%(101/372)、艾司唑仑26.9%(65/372)和雷贝拉唑14.8%(55/372)。PIM组患者年龄、服药数量、衰弱评分、CCI和6 m步速降低比例高于非PIM组患者,日常生活能力(ADL)量表和工具性日常生活能力(IADL)量表评分低于非PIM组患者,差异具有统计学意义(P＜0.05)。Spearman相关分析显示PIM与年龄(r＝0.152,P＝0.003)、服药数量(r＝0.493,P＜0.001)、CCI(r＝0.126,P＝0.015)、6 m步速降低(r＝0.110,P＝0.034)、衰弱量表评分(r＝0.141,P＝0.006)呈正相关,与ADL评分(r＝-0.131,P＝0.011)和IADL评分(r＝-0.128,P＝0.014)呈负相关。多因素logistic回归分析表明,服药数量为PIM的危险因素(OR＝1.604,95%CI 1.427～1.804；P＜0.001)。结论 老年住院患者服药数量是PIM的危险因素,临床医师应重视PIM,加强合理用药,尽可能减少处方药物数量。

Abstract:

Objective To investigate the association between potentially inappropriate medication (PIM) and comorbidity, frailty and disability in the hospitalized elderly inpatients. Methods Selected for the study were 372 inpatients aged ≥65 years old in the Integrated Department of Fu Xing Hospital of Capital Medical University from June 2016 to June 2017. According to the PIM list for the elderly Chinese (version 2017), the patients were divided into PIM group (n=238) and non-PIM group (n=134), and data were recorded of their general information, comorbidity, and Charlson comorbidity index (CCI), frailty and disability. SPSS statistics 23.0 was used to process data. Independent sample t-test, nonparametric test or χ² test was performed. Spearman correlation analysis was made to explore correlation between PIM and comorbidity, frailty and disability. Multivariate logistic regression was done to analyze the risk factors associated with PIM. Results The incidence of PIM was 64.0%(238/372), with top three being clopidogrel 27.2%(101/372), eszolam 26.9%(65/372) and rabeprazole 14.8%(55/372). Compared with the non-PIM group, the PIM group were more advanced in age and number of prescribed medicines, had higher frailty score and CCI, and greater decline in the 6-m walking speed , but lower ADL and IADL. The difference was statistically significant (P<0.05). Spearman correlation analysis showed that PIM positively correlated with age (r=0.152, P=0.003), drugs number (r=0.493, P<0.001), CCI (r＝0.126, P＝0.015), decline in 6-m walking speed (r＝0.110, P=0.034) and frailty scale (r＝0.141, P=0.006) but negatively correlated with ADL (r＝-0.131, P=0.011) and IADL (r＝-0.128, P=0.014). Multivariate logistic regression suggested that the drugs number was a risk factor for PIM (OR=1.604,95%CI 1.427-1.804;P<0.001). Conclusion The number of drugs administered is a risk factorfor PIM in the elderly inpatients, and accordingly, clinicians should pay more attention to PIM by strengthening rationality in medication and minimize the number of prescribed drugs.