老人潛在不適當用藥之文獻回顧

Review of Potentially Inappropriate Medication in the Elderly

林香汶(Hsiang-Wen Lin) ； 賴況潔(Kuang-Chieh Lai) ； 林志學(Chih-Hsueh Lin)

《長期照護雜誌》 23卷2期 (2019/10) Pp. 95-110

https://doi.org/10.6317/LTC.201910_23(2).0001

摘要

當老人之處方藥物治療風險大過於益處時即被視為潛在不適當用藥，不適當用藥與藥物安全問題有著很大的關係，自從世界各國評估老人用藥適當性工具及準則被發表後，陸續有許多相關研究文獻，本文以敘述性回顧方式檢視老人不適當用藥準則，探討國內外相關文獻及研究結果，也特別介紹臺灣老人潛在不適當用藥準則及最常被使用的美國老人潛在不適當用藥準則。老年族群潛在性不適當用藥型態及盛行率，隨著不同的準則、國家、區域或被評估老人的機構型態不同而有所差異，經文獻統整後發現，許多國家已依據本身老年族群的藥物流行病學及現有藥物等相關因素，發展出比較符合該國的潛在性不適當用藥準則來使用，以促使該國或區域的老年族群的用藥可以被最適切的評估，並及早預防不良反應的發生。希望此文能提供給醫療專業人員，於提供長期或中期照護之老人個別化藥療管理與照護時之實證參考，以促使醫療專業人員能使用最適當的工具或準則來評估老人用藥適當性，為老人用藥安全之提昇共盡一己之力。

關鍵字

老人 ； 潛在不適當用藥 ； 準則 ； 用藥安全

並列摘要

Potentially inappropriate medication (PIM) in the elderly occurs when the risks of use overweight the benefit, and it is strongly associated with the concerns of drug safety. Since many countries have proposed their PIM criteria in response to drug safety in the elderly, more and more relevant clinical research was published. This narrative review examined PIM for the elderly and summarizes the relevant literature and research findings. In particular, we introduced the PIM-Taiwan and the most commonly used PIM criteria, which was verified and modified by the American Geriatric Association. The assessment and prevalence of PIM for the elderly could vary by different criteria, countries and care institutes. Many countries have tried to establish applicable assessment criteria based upon their own pharmacoepidemiologic findings and available medication lists to facilitate appropriateness assessment and prevent adverse drug reactions from happening. This review was performed to provide evidence to enhance better quality of care in medication management and decision making toward the elderly who are taken care in the long-term or intermediate care units in the future. Hopefully, the health professionals could use the most appropriate assessment tool or criteria to provide efficient and collaborative care and improve elderly patients' medication safety.

並列關鍵字

elderly ； potentially inappropriate medication ； criteria ； medication safety

參考文獻

American Geriatrics Society 2015 Beers Criteria Update Expert Panel. (2015). American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 63(11), 2227-2246. doi:10.1111/jgs.13702

American Geriatrics Society Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria(R) for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 67(4), 674-694. doi:10.1111/jgs.15767

Bahat, G., Bay, I., Tufan, A., Tufan, F., Kilic, C., & Karan, M. A. (2017). Prevalence of potentially inappropriate prescribing among older adults: A comparison of the Beers 2012 and Screening Tool of Older Person's Prescriptions criteria version 2. Geriatrics & Gerontology International, 17(9), 1245-1251. doi:10.1111/ggi.12850

Barry, P. J., Gallagher, P., Ryan, C., & O'Mahony, D. (2007). START (screening tool to alert doctors to the right treatment)-- an evidence-based screening tool to detect prescribing omissions in elderly patients. Age and Ageing, 36(6), 632-638. doi:10.1093/ageing/afm118

Blanco-Reina, E., Ariza-Zafra, G., Ocana-Riola, R., & Leon-Ortiz, M. (2014). 2012 American Geriatrics Society Beers criteria: Enhanced applicability for detecting potentially inappropriate medications in European older adults? A comparison with the Screening Tool of Older Person's Potentially Inappropriate Prescriptions. Journal of the American Geriatrics Society, 62(7), 1217-1223. doi:10.1111/jgs.12891