With the acceleration of society’s aging process,the widespread phenomenon of polypharmacy among the elderly has become a significant concern.This research aimed to analyze potential inappropriate medication among 17...With the acceleration of society’s aging process,the widespread phenomenon of polypharmacy among the elderly has become a significant concern.This research aimed to analyze potential inappropriate medication among 178 inpatients in the geriatric general department of our hospital from January 2022 to September 2022.The participants were randomly assigned to an observation group and a control group.The observation group received pharmaceutical intervention,whereas the control group did not.The objective was to explore the impact of pharmaceutical intervention on polypharmacy in this population.The results revealed that after pharmaceutical intervention,there were no significant differences in medication adherence,medication appropriateness index(MAI),quantity of medicine,and potentially inappropriate medication(PIM)in the control group compared to before the intervention(P>0.05).However,the observation group showed significant improvement(P<0.05).The proportion of patients with good adherence increased from 57%to 78%,and the percentage of patients with MAI scores over 10 decreased from 60%to 40%.Moreover,there was a reduction in the number of medications prescribed,with only 47%of patients receiving more than five different types compared to the initial rate of 64%.Additionally,the occurrence of PIM declined from an initial rate of 64%to just 44%,surpassing that observed in the control group.Therefore,the implementation of pharmaceutical intervention can effectively enhance medication adherence and appropriateness among elderly patients,mitigate the risk of PIM,and promote rational medicine utilization.展开更多
Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older p...Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selectionin older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drugdrug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.展开更多
Background： Polyphamlacy and potentially inappropriate medications （PIMs） are prominent prescribing issties in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatien...Background： Polyphamlacy and potentially inappropriate medications （PIMs） are prominent prescribing issties in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatients between 65-70 years of age and 80 years or older, who were discharged from Geriatric Depamnent in West China Hospital. Methods： 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 Anaerican Geriatric Society was applied to assess the use of PIM among the investigated samples. Results： A review of the prescribed medications identified 686 patients aged 80 years or older constimed at least one PIM giving a rate of 58.2%. Conversely, 268 （43.4%） patients aged 65-79 years consumed at least one PIM （x^2=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 with P 〈 0.001 ）. Patients aged 80 years or older were prescribed with more benzodiazepines, drugs with strong anticholmergic 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. Conclusions： 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.展开更多
基金Hospital Pharmacy Research Foundation of Guangdong(Grant No.2022A14)。
文摘With the acceleration of society’s aging process,the widespread phenomenon of polypharmacy among the elderly has become a significant concern.This research aimed to analyze potential inappropriate medication among 178 inpatients in the geriatric general department of our hospital from January 2022 to September 2022.The participants were randomly assigned to an observation group and a control group.The observation group received pharmaceutical intervention,whereas the control group did not.The objective was to explore the impact of pharmaceutical intervention on polypharmacy in this population.The results revealed that after pharmaceutical intervention,there were no significant differences in medication adherence,medication appropriateness index(MAI),quantity of medicine,and potentially inappropriate medication(PIM)in the control group compared to before the intervention(P>0.05).However,the observation group showed significant improvement(P<0.05).The proportion of patients with good adherence increased from 57%to 78%,and the percentage of patients with MAI scores over 10 decreased from 60%to 40%.Moreover,there was a reduction in the number of medications prescribed,with only 47%of patients receiving more than five different types compared to the initial rate of 64%.Additionally,the occurrence of PIM declined from an initial rate of 64%to just 44%,surpassing that observed in the control group.Therefore,the implementation of pharmaceutical intervention can effectively enhance medication adherence and appropriateness among elderly patients,mitigate the risk of PIM,and promote rational medicine utilization.
文摘Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selectionin older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drugdrug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.
基金This work was supported in part by grants from the National Natural Science Foundation of China，Outstanding Scholar Foundation of Sichuan University，Program of Health and Family Planning Commission of Sichuan Province，Program of Science and Technology Department of Sichuan Province
文摘Background： Polyphamlacy and potentially inappropriate medications （PIMs） are prominent prescribing issties in elderly patients. This study was to investigate the different prevalence of PIM use in elderly inpatients between 65-70 years of age and 80 years or older, who were discharged from Geriatric Depamnent in West China Hospital. Methods： 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 Anaerican Geriatric Society was applied to assess the use of PIM among the investigated samples. Results： A review of the prescribed medications identified 686 patients aged 80 years or older constimed at least one PIM giving a rate of 58.2%. Conversely, 268 （43.4%） patients aged 65-79 years consumed at least one PIM （x^2=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 with P 〈 0.001 ）. Patients aged 80 years or older were prescribed with more benzodiazepines, drugs with strong anticholmergic 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. Conclusions： 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.
