老年住院患者潜在不适当用药与内在能力下降的相关性

Correlation between potentially inappropriate medication and decline of intrinsic capacity in elderly inpatients

目的探讨老年住院患者潜在不适当用药(PIM)与内在能力(IC)下降的相关性。方法选择2022年1月至6月于首都医科大学附属复兴医院住院的215例老年患者为研究对象,根据中国老年人PIM目录确定PIM,将患者分为PIM组(125例)和非PIM组(90例),记录患者共病情况、口服药种类,评估IC等指标。应用SPSS 23.0统计软件进行数据处理。根据数据类型,分别采用独立样本t检验、Mann-Whitney U检验或χ^(2)检验进行组间比较。采用Spearman相关性分析PIM与IC下降的相关性。采用多因素logistic回归分析PIM发生的危险因素。结果患者年龄60~109(84.0±7.0)岁,男性134例(62.3%),IC评分2.0(1.0,3.0)分,93.0%(200/215)患者存在IC下降,其中运动能力下降者占75.8%(163/215),IC下降≥3分者占40.0%(86/215)。口服药种类0~17种/人,人均6.0(3.0,8.0)种,服用≥5种口服药者占63.3%(136/215),PIM使用率为58.1%(125/215)。查尔森共病指数(CCI)为7.0(6.0,9.0)分。与非PIM组比较,PIM组患者年龄、CCI、失眠、便秘、呛咳、多重用药、口服药种类及IC评分明显增加,IC 5项评分标准中运动能力下降最为明显,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,PIM与年龄、IC评分、多重用药及CCI呈显著正相关(r=0.167,0.205,0.468,0.214;P<0.05)。多因素logistic回归分析显示,在调整年龄、性别、疾病严重程度及多重用药因素后,IC评分下降是PIM的危险因素(OR=1.567,95%CI 1.102~2.228;P<0.05)。结论IC下降是老年住院患者PIM的危险因素,应加强对IC下降的老年住院患者进行PIM筛查,减少PIM使用。

Objective To investigate the correlation between potentially inappropriate medication(PIM)and decline of intrinsic capacity(IC)in the elderly inpatients.Methods A total of 215 elderly inpatients admitted to the Fu xing Hospital Affiliated to Capital Medical University from January 2022 to June 2022 were analyzed.The patients were divided into PIM group(125 cases)and non-PIM group(90 cases)according to the PIM categories for the elderly in China.The comorbidity,types of oral drugs,IC and other indicators of patients were recorded.SPSS statistics 23.0 was used to analyze the data.Independent sample t test,Mann-Whitney U test or Chi-square test was used for comparison between groups.Spearman correlation analysis was used to analyze the correlation between PIM and intrinsic capacity decline.Multivariate logistic regression was used to analyze the related risk factors of PIM.Results The patients were aged 60-109(84.0±7.0)years,and 134(62.3%)were males.The patients scored 2.0(1.0,3.0)points for intrinsic capacity.Decreased intrinsic capacity was seen in 93.0%(200/215)patients,and decreased motor ability in 75.8%(163/215).Intrinsic capacity decline≥3 accounted for 40.0%(86/215).The types of oral drugs ranged from 0 to 17,with 6.0(3.0,8.0)types per person,and 63.3%(136/215)patients took more than 5 oral drugs.The rate of PIM use was 58.1%(125/215).Charlson comorbidity index(CCI)was 7.0(6.0,9.0)points.Compared with the non-PIM group,the PIM group had significantly increased age,CCI,insomnia,constipation and choking,polypharmacy,more types of oral medication and IC score(P<0.05),but among the five scoring criteria of IC,exercise capacity decreased,the difference being statistically significant(P<0.05).Spearman correlation analysis showed that PIM was positively correlated with age,intrinsic capacity score,polypharmacy and CCI(r=0.167,0.205,0.468,0.214;P<0.05).Multivariate logistic regression analysis showed that decreased IC score(OR=1.567,95%CI 1.102-2.228;P<0.05)was a risk factor for PIM after adjusting for age,gender,disease severity and polypharmacy.Conclusion Decreased IC is a risk factor for PIM in the elderly inpatients,and PIM should be screened in the elderly inpatients with decreased intrinsic capacity to reduce PIM use.