老年患者潜在不适当用药与跌倒的相关性

Association of potentially inappropriate medications with falls in elderly patients

摘要:

目的 探讨老年患者潜在不适当用药(PIM)与跌倒的关系。方法 采取横断面研究,纳入2017年1月至2017年12月首都医科大学附属复兴医院综合科住院患者280例(≥65岁)。根据入院前6个月有无跌倒史分为2组:跌倒组(n=36)和非跌倒组(n=244)。收集患者一般资料,测试握力、步速等临床资料。采用查尔森共病指数(CCI)评估疾病,微型营养评估简表(MNA-SF)筛查患者营养状态。采用SPSS 23.0软件进行统计分析,依据数据类型采用t检验、非参数检验或χ²检验。正态分布资料采用Pearson相关分析,非正态分布资料采用Spearman相关分析。采用logistic回归分析筛选出独立的危险因素。结果 入选患者的PIM使用率为69.3%(194/280)。精神类PIM使用率为36.1%(101/280),心血管PIM使用率为22.9%(64/280),其他类PIM使用率为8.9%(25/280)。跌倒组中服用精神类PIM患者比例显著高于非跌倒组(58.3% vs 32.8%,P=0.005)。相关分析显示,跌倒与骨质疏松(r=0.238,P＜0.001)、焦虑抑郁(r=0.170,P＜0.004)、服用≥5种口服药(r=0.123,P=0.040)、服用精神类PIM(r=0.178,P=0.004)和女性(r=0.230,P=0.006)呈显著正相关,与握力(r=-0.146,P=0.015)和步速(r=-0.134,P=0.025)呈显著负相关。logistic回归分析显示,跌倒与骨质疏松(OR=3.973,95%CI 1.759～8.973,P=0.001)和服用精神类PIM(OR=2.415,95%CI 1.141～5.114,P=0.021)相关。结论 老年患者服用精神类PIM与跌倒相关。临床医师应加强合理用药,避免精神类PIM特别是A级(优先警示)药物使用,减少老年患者跌倒风险。

Abstract:

Objective To investigate the association of the potentially inappropriate medications (PIM) with falls in the elderly patients. Methods A retrospective cross-sectional study was conducted of 280 inpatients aged ≥65 years who were divided into fall group (n=36) and non-fall group (n=244) based on a history of falling six months before admission. Patients′ general data were collected, and their clinical data such as hand-grip strength and walking speed were measured. Patients were assessed using Charlson comorbidity index (CCI) and mini nutritional assessment-short form (MNA-SF) scale. SPSS statistics 23.0 was used for statistical analysis, and t test, non-parametric test or χ² test was performed, depending on data types. Pearson correlation was used for the normal distribution, and Spearman correlation for the non-normal distribution data. Logistic regression was run to screen for independent risk factors. Results PIM among the enrolled patients were highly prevalent (69.3%,194/280), with psychotropic accounting for 36.1%(101/280), cardiovascular for 22.9%(64/280) and others for 8.9%(25/280). Significantly more patients using psychotropic PIM in the fall group than the non-fall group (58.3% vs 32.8%, P=0.005). Correlation analysis showed that falls were positively associated with osteoporosis (r=0.238, P<0.001), anxiety depression (r=0.170, P<0.004), use of ≥5 oral drugs (r=0.123, P=0.040), psychotropic PIM (r=0.178, P=0.004) and female (r=0.230, P=0.006), and negatively with hand-grip strength (r=-0.146,P=0.015)and walking speed (r=-0.134, P=0.025). Logistic regression showed falls correlated with osteoporosis (OR=3.973, 95%CI 1.759-8.973,P=0.001) and psychotropic PIM (OR=2.415,5%CI 1.141-5.114, P=0.021). Conclusion Psychotropic PIM was associated with falls in the elderly patients. Clinicians should be more mindful of rational prescrip-tions to avoid overuse of psychotropic PIM, particularly drugs of category A (high-alert), thus reducing the risk of fall in the elderly patients.