基于2019版Beers标准评价老年住院患者潜在不适当用药发生率及危险因素

Prevalence and Risk Factors of Potential Inappropriate Medication in Elderly Hospitalized Patients Based on Beers Criteria(2019 edition)

目的使用2019版Beers标准评价老年住院患者潜在不适当用药的情况及其危险因素。方法随机选取新疆维吾尔自治区第一济困医院2020年1月-2022年12月老年住院患者(≥65岁)的用药医嘱,以2019版Beers标准为依据,评价潜在不适当用药的发生率,对性别、年龄、疾病种数、用药次数等因素进行Logistic回归分析,寻找可能造成潜在不适当用药的危险因素。结果本研究共回顾分析了502例老年患者的病案(女性51.6%,男性48.4%)。潜在不适当用药的发生率为34.7%。其中以抗精神病药(27.5%)和磺脲类药物(16.8%)最为常见。肾功能不全患者中的潜在不适当用药主要为抗凝剂(40%)和雷尼替丁(35%)。女性[OR 1.8;95%CI(1.22-2.66),P<0.05]和用药次数的增加[OR 1.08;95%CI(1.03-1.14),P<0.05]是潜在不适当用药的独立危险因子。结论通过应用2019版Beers标准评价老年患者的潜在不适当用药情况,临床药师应加大抗精神疾病药物和磺脲类药物的监管,临床医师应注意抗凝剂和雷尼替丁在老年肾功能不全患者中的应用,对女性和需增加用药次数的老年患者重点关注,从而降低潜在不适当用药的发生率。

Objective The Potential inappropriate drug use(PIMs)and its associated risk factors in hospitalized elderly patients were evaluated using the 2019 edition Beers criteria.Methods Medication orders of elderly(≥65 years old)hospitalized patients in the First Aid Hospital of Xinjiang Uygur Autonomous Region from January 2020 to December 2022 were randomly selected.Beers criteria(2019 edition)were used as the basis to evaluate potential inappropriate drug use.Logistic regression analysis was performed on the occurrence of PIM in different patients,such as gender,age,number of diseases and times of medication,to find the risk factors of PIM occurrence.Results A total of 502 elderly patients(female 51.6%,male 48.4%)were reviewed and analyzed.The incidence of PIM in the study population was 34.7%.Antipsychotics(27.5%)and sulfonylureas(16.8%)were the most common PIMs.Anticoagulants(40%)and ranitidine(35%)were the drugs with the highest incidence of PIM in patients with renal insufficiency.Gender being female[OR 1.8;95%CI(1.22-2.66),P<0.05]and increased medication frequency[OR 1.08;95%CI(1.03-1.14),P<0.05]were independent predictors of PIM.Conclusion Based on the incidence of PIM in elderly patients,the Beers criteria(2019 edition)were evaluated to recommend that clinicians modify the treatment regiments and increase the regulation of antipsychotics and sulfonylureas,with particular attention to the use of anticoagulants and ranitidine in elderly patients.Focus on women and older patients who need more medication to reduce the incidence of PIM.