老年患者潜在不适当用药与跌倒的相关性

Association of potentially inappropriate medications with falls in elderly patients

目的探讨老年患者潜在不适当用药(PIM)与跌倒的关系。方法采取横断面研究,纳入2017年1月至2017年12月首都医科大学附属复兴医院综合科住院患者280例(≥65岁)。根据入院前6个月有无跌倒史分为2组:跌倒组(n=36)和非跌倒组(n=244)。收集患者一般资料,测试握力、步速等临床资料。采用查尔森共病指数(CCI)评估疾病,微型营养评估简表(MNA-SF)筛查患者营养状态。采用SPSS 23.0软件进行统计分析,依据数据类型采用t检验、非参数检验或χ2检验。正态分布资料采用Pearson相关分析,非正态分布资料采用Spearman相关分析。采用logistic回归分析筛选出独立的危险因素。结果入选患者的PIM使用率为69.3%(194/280)。精神类PIM使用率为36.1%(101/280),心血管PIM使用率为22. 9%(64/280),其他类PIM使用率为8.9%(25/280)。跌倒组中服用精神类PIM患者比例显著高于非跌倒组(58. 3%vs 32. 8%,P=0. 005)。相关分析显示,跌倒与骨质疏松(r=0. 238,P <0. 001)、焦虑抑郁(r=0. 170,P <0. 004)、服用≥5种口服药(r=0. 123,P=0. 040)、服用精神类PIM (r=0. 178,P=0. 004)和女性(r=0. 230,P=0. 006)呈显著正相关,与握力(r=-0. 146,P=0. 015)和步速(r=-0. 134,P=0. 025)呈显著负相关。logistic回归分析显示,跌倒与骨质疏松(OR=3. 973,95%CI1. 759～8. 973,P=0. 001)和服用精神类PIM(OR=2. 415,95%CI 1. 141～5. 114,P=0. 021)相关。结论老年患者服用精神类PIM与跌倒相关。临床医师应加强合理用药,避免精神类PIM特别是A级(优先警示)药物使用,减少老年患者跌倒风险。

Objective To investigate the association of the potentially inappropriate medications(PIM)with falls in the elderly patients.Methods A retrospective cross-sectional study was conducted of 280 inpatients aged≥65 years who were divided into fall group(n=36)and non-fall group(n=244)based on a history of falling six months before admission.Patients′general data were collected,and their clinical data such as hand-grip strength and walking speed were measured.Patients were assessed using Charlson comorbidity index(CCI)and mini nutritional assessment-short form(MNA-SF)scale.SPSS statistics 23.0 was used for statistical analysis,and t test,non-parametric test orχ^2 test was performed,depending on data types.Pearson correlation was used for the normal distribution,and Spearman correlation for the non-normal distribution data.Logistic regression was run to screen for independent risk factors.Results PIM among the enrolled patients were highly prevalent(69.3%,194/280),with psychotropic accounting for 36.1%(101/280),cardiovascular for 22.9%(64/280)and others for 8.9%(25/280).Significantly more patients using psychotropic PIM in the fall group than the non-fall group(58.3%vs 32.8%,P=0.005).Correlation analysis showed that falls were positively associated with osteoporosis(r=0.238,P<0.001),anxiety depression(r=0.170,P<0.004),use of≥5 oral drugs(r=0.123,P=0.040),psychotropic PIM(r=0.178,P=0.004)and female(r=0.230,P=0.006),and negatively with hand-grip strength(r=-0.146,P=0.015)and walking speed(r=-0.134,P=0.025).Logistic regression showed falls correlated with osteoporosis(OR=3.973,95%CI 1.759-8.973,P=0.001)and psychotropic PIM(OR=2.415,95%CI 1.141-5.114,P=0.021).Conclusion Psychotropic PIM was associated with falls in the elderly patients.Clinicians should be more mindful of rational prescrip-tions to avoid overuse of psychotropic PIM,particularly drugs of category A(high-alert),thus reducing the risk of fall in the elderly patients.