老年人用药依从性及其相关影响因素分析

Medication adherence and the related influential factors among the elderly patients

目的探讨老年患者的用药依从性及其相关的危险因素。方法纳入≥65岁老年患者209例,对患者进行用药依从性调查及老年综合评估。分析患者的一般资料、患病情况及常见老年综合征对用药依从性的影响。结果 209例患者中27.3%未能遵医嘱用药。用药依从性差与多重用药、抑郁、衰弱和日常生活活动能力下降相关(P<0.05);焦虑患者的依从性相对较高(P<0.05);共病患者较单病患者的用药依从性好(P<0.05)。多因素logistic回归提示,抑郁、跌倒史以及日常生活活动能力下降是用药依从性差的危险因素(P<0.05)。结论老年患者的慢病、老年综合征及功能状态影响用药依从性,尤其是抑郁和躯体功能下降、衰弱及多重用药。需要加强对老年人的用药宣教和管理。

Objective To assess medication adherence among the elderly patients and to identify probable risk factors.Methods The elderly patients admitted to the geriatric ward in Peking Union Medical College Hosptital from September 2016 to December 2017 were investigated with comprehensive geriatric assessment(CGA)by the trained doctors,including sociodemographic information,multiple chronic conditions,medications and medication adherence,and common geriatric syndromes such as visual impairment,hearing impairment,urinary incontinence,falls,malnutrition,cognitive impairment,depression,anxiety,and frailty.Data were analyzed using SPSS version 20.0 software(SPSS,Inc.,Chicago,IL).Results 209 inpatients of more than 65 years old were included in the final analysis,57(27.3)%of respondents self-reported nonadherent to some extent.By pearsonχ2 analysis,non-adherence to medication correlated with the polypharmacy,depression,impaired ADL,and frailty(P<0.05).Patients with comorbidities had a better adherence than those with single common chronic disease(P<0.05).Logistic analysis showed that depression,falls and impaired ADL were the risk factors(P<0.05).Conclusion The frail elderly patients with polypharmacy,depression,impaired ADL should be the target population of medication adherence management.In addition,the patients with single chronic disease also need more health education.