護理之家年長住民潛在不適當處方之相關危險因子

Risk Factors of Potentially Inappropriate Prescribing among Older Residents in Nursing Home

翁茂中(Mao-Chung Weng)

指導教授 ： 陳宣志

中山醫學大學/醫學院/醫學研究所/碩士(2017年)

摘要

前言：老人潛在不適當用藥問題在國內外逐漸受到重視，因老化及慢性疾病狀態，潛在不適當處方增加發生藥物不良反應之機會。護理之家年長住民因共病症較複雜，許多研究都顯示潛在性不適當處方之盛行率較一般老年人高，而其相關危險因子仍未有明確定論。本研究意欲探究護理之家年長住民之潛在不適當處方之盛行率以及相關危險因子。
方法：本研究資料取自2015年7月至12月臺灣中部四間護理之家接受某區域醫院家醫科門診開立慢性處方之60歲以上207位年長住民，根據病歷紀錄患者之年齡、性別、慢性病狀態以及處方藥物，使用2015年Beers Criteria評估患者潛在性不適當處方。以Student’s t檢定和卡方檢定各變項與潛在性不適當處方之相關性，進而以多變項邏輯斯迴歸模式分析，探究潛在性不適當處方之危險因子。
結果：研究對象平均年齡為81.2 ± 9.5歲；平均慢性病數目為5.8 ± 1.6種；平均藥物數目為6.3 ± 2.2個；平均Charlson’s comorbidity index為3.7± 2.1分；平均巴氏量表分數為4.3± 11.2分。其中136位(65.7%)有一項以上潛在性不適當處方。207位患者常見之慢性病診斷為消化系統疾病(75.4%)、循環系統疾病(68.1%)以及神經系統疾病(60.4%)。136位患者服用之PIM，常見的包括抗精神病藥物(28.0%)、Metoclopramide(25.4%)、苯二氮平類藥物(21.7%)以及H2受體阻斷劑(13.0%)。經多變項邏輯斯回歸分析顯示，潛在性不適當處方與藥物數目(勝算比= 1.42；95%信賴區間= 1.19-1.69；p < 0.001)及精神科疾病(勝算比= 4.38；95%信賴區間= 2.26-8.50；p < 0.001)有關。
結論：本研究顯示潛在不適當處方在護理之家年長住民中並不少見，臨床醫師對於多種藥物處方及精神科疾病患者，應考慮其高風險性潛在不適當處方的可能性。

關鍵字

危險因子 ； 年長 ； 潛在不適當處方 ； 護理之家住民 ； 慢性病

並列摘要

Objective: Problems related to inappropriate prescriptions for older patients is considered a major public health issue in recent studies. Potentially inappropriate medications(PIMs) in elderly could could lead to an increase in the likelihood of adverse drug events because of aging and multiple chronic comorbidities. The prevalence of PIM use was high in nursing home residents in previous studies, but the factors associated with potentially inappropriate medication still had some controversies. The aim of our study is to identify the prevalence and risk factors for PIM use in older nursing home residents.
Methods: This study included 207 consecutive patients, aged ≥ 60 years, living in 4 nursing homes in central Taiwan, who received long-term prescriptions in family medicine clinics at a regional hospital between July 1 and December 31, 2015. PIM was assessed according to the 2015 updated Beers Criteria. Data regarding demographic characteristics, coexisting diseases, and prescriptions were collected and analyzed. The clinical factors related to PIM were determined using logistic regression.
Results: The mean age of the 207 residents was 81.2 ± 9.5 years. The mean number of comorbid conditions was 5.8 ± 1.6; the mean number of drugs prescribed was 6.3 ± 2.2. PIM was identified in 136 residents (65.7%). Most common chronic disease was diseases of digestive system (75.4%), followed by disease of circulatory system (68.1%) and disease of nervous system (60.4%). Most common PIMs were antipsychotics (28.0%), followed by metoclopramide (25.4%), benzodiazepines (21.7%), and H2-antagonists (13.0%). Multivariate analysis revealed that PIM was significantly associated with the number of drugs prescribed (p< 0.001) and psychiatric illnesses (p< 0.001).
Conclusions: The prevalence of PIM in older nursing home residents was not rare. Clinicians should be alert to the possibility of PIM in older nursing home residents, especially in those taking multiple medications and those who have psychiatric illnesses.

並列關鍵字

risk factor ； elderly ； potentially inappropriate prescribing ； nursing home residents ； chronic disease

參考文獻

21. 李惠超、童俊欽、賴永融、蔡敏玲。老年長期處方及潛在性不適當用藥之危險因子探討。臺灣臨床藥學雜誌2014；22：9-18。

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