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首页> 外文期刊>Journal of the American Pharmaceutical Association: APhA >The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence.
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The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence.

机译：老年人不适当处方的持续挑战：证据的更新。

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OBJECTIVES: To provide an updated review of the literature on the extent of and risk factors for inappropriate prescribing in the elderly. METHODS: A comprehensive review of the most recent publications in English assessing inappropriate prescriptions for elderly patients in the United States using the 1997 version of the Beers explicit criteria. The reviewed articles were obtained via an electronic search of the MEDLINE database for articles published between 1997 and 2001 and a manual search through major journals for articles referenced in those located through MEDLINE. Search terms were Beers, explicit criteria, inappropriate drug use, prescribing, prescriptions, medication use, elderly, and health outcomes. RESULTS: Using the updated explicit criteria, a total of 11 empirical studies were identified, all of which were conducted using observational surveys or claims databases. The reported prevalence of elderly patients using at least one inappropriately prescribed drug ranged from a high of 40% for a population of nursing home patients to 21.3% for community-dwelling patients over age 65. Propoxyphene, amitriptyline, long-acting benzodiazepines (e.g., chlordiazepoxide, diazepam, flurazepam), and dipyridamole are among the most commonly occurring inappropriate prescriptions. With a few exceptions, the most significant patient-related predictors of inappropriate prescribing include polypharmacy, poor health status, and female sex. Other potential risk factors include prescribing location, ethnicity, age, and referral status. Limited evidence was found of increased health care utilization and poorer quality of life resulting from inappropriate drug use in the elderly in Medicare health maintenance organization and emergency department settings. CONCLUSION: The prevalence of inappropriate prescribing remains alarmingly high for the elderly in general and for nursing home residents in particular. This review identified some attributes of the elderly groups most vulnerable to inappropriate prescribing. Future research should document more evidence regarding the adverse impact of inappropriate prescribing on total health care costs and patient health outcomes.
机译：目的：提供有关老年人不适当处方的程度和危险因素的文献的最新综述。方法：使用1997版比尔斯（Beers）显式标准对美国老年人使用不合适的处方进行评估的英语最新出版物的全面综述。通过对MEDLINE数据库的电子搜索来检索1997年至2001年之间发表的文章，并通过主要期刊手动搜索通过MEDLINE查找的文章中引用的文章，从而获得了审阅的文章。搜索词包括啤酒，明确标准，不适当的药物使用，处方，处方，药物使用，老年人和健康状况。结果：使用更新的明确标准，总共鉴定了11个经验研究，所有这些研究均使用观察性调查或索赔数据库进行。据报道，使用至少一种不适当处方药物的老年患者患病率从养老院患者人群的40％到65岁以上社区居民的21.3％不等。丙氧芬，阿米替林，长效苯二氮卓类药物（例如，氯二氮卓，地西epa，氟拉西m和双嘧达莫是最常见的不适当处方。除少数例外，与患者相关的最重要的不适当处方预测因素包括多药店，不良健康状况和女性。其他潜在的风险因素包括处方地点，种族，年龄和转诊状况。在Medicare健康维护组织和急诊部门中，发现老年人使用不当药物导致的医疗保健利用率提高和生活质量降低的证据有限。结论：总体上，不适当处方的患病率仍然居高不下，特别是对于老年人，尤其是对疗养院居民。这项审查确定了老年人群最容易受到不适当处方的一些属性。未来的研究应记录更多有关不适当处方对总医疗费用和患者健康结果的不利影响的证据。

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