老年人潜在不恰当用药与衰弱危险因素之间的相关性及研究进展

Association and research progress between potentially inappropriate medication and the risk factors of frailty in the elderly

我国正进入老龄化阶段,老年人药代动力学及药效学下降极易引起药物体内蓄积产生药物相关不良反应。老年人多病共存现象普遍,多重用药及潜在不恰当用药(potential inappropriate medication,PIM)使用风险较高,潜在不恰当用药目录的制定可对引起老年人不良反应的药物进行有效筛查,以此规范老年人合理用药。衰弱是老年人常见的疾病,可引起入院率升高、住院时间延长、失能、死亡等严重不良结局,是我国重大公共卫生问题之一。随着人们对于健康的需求越来越普遍,对衰弱的认知显得尤为重要。引起衰弱的危险因素较多,年龄、收入、生活方式、健康状况、营养状况、多重用药等,对危险因素的识别可更全面系统的认知衰弱,以期早期进行有效干预,延缓衰弱的发生发展、提高老年人生活质量、减轻医疗负担。目前已有诸多研究显示潜在不恰当用药与衰弱及衰弱危险因素之间存在显著相关性,我国对潜在不恰当用药关注较晚,相关研究较少,本文通过对国内外相关文献的整理就老年人身体功能、认知功能、睡眠障碍、营养不良等方面研究现状对两者之间的相关性进行综述,提高人们对潜在不恰当用药的重视程度,引起临床医生重视,注重个体化治疗及药物不良反应检测,以规范老年人合理用药,为我国衰弱的研究提供参考。

China is entering the ageing stage,and elderly pharmacokinetics and pharmacodynamics very easily causes drug accumulation in body drug-related adverse reactions.Multi-drug use and potential inappropriate medication(PIM)are at high risk in the elderly,and the development of a catalogue of PIM can effectively screen the drugs causing adverse reactions in the elderly to regulate their rational use of drugs.Frailty is a common disease in the elderly,which can lead to high hospitalisation rate,prolonged hospitalisation,disability,and death.It is one of the major public-health problems in China.As the need for health becomes more common,the perception of frailty becomes more important.Age,income,lifestyle,health status,nutrition status,multiple drug use,and so on are the risk factors of frailty.The identification of risk factors can lead to a more comprehensive and systematic cognitive frailty for effective intervention at an early stage,delay the occurrence and development,improve the quality of life of the elderly,and reduce medical burden.Many studies have shown that a significant correlation existed between PIM and frailty and the risk factors of frailty,but few relevant literature exists in China.In this study,the correlations amongst physical function,cognitive function,sleep disorder,malnutrition,and other aspects of the elderly are reviewed through relevant literature at home and abroad.To standardise the rational use of drugs in the elderly,we should pay more attention to the PIM,the individual treatment,and the detection of adverse drug reactions.Our findings can serve as a reference for the research on China's declination.