Abstract：
Comprehensively investigate prescribing in usual care of hospitalized older people with respect to polypharmacy; potentially inappropriate medications (PIMs) according to Beers criteria; and cumulative anticholinergic and sedative medication exposure calculated with Drug Burden Index (DBI). Specifically, to quantify exposure to these measures on admission, changes between admission and discharge, associations with adverse outcomes and medication costs.
Established new retrospective inpatient cohort of 2000 adults aged ≥75 years, consecutively admitted to 6 hospitals in Sydney, Australia, with detailed information on medications, clinical characteristics and outcomes. Conducted cross-sectional analyses of index admission data from cohort.
Cohort had mean (standard deviation) age 86.0 (5.8) years, 59% female, 21% from residential aged care. On admission, prevalence of polypharmacy was 77%, PIMs 34% and DBI > 0 in 53%. From admission to discharge, mean difference (95% confidence interval) in total number of medications increased 1.05 (0.92, 1.18); while prevalence of exposure to PIMs (-3.8% [-5.4, -2.1]) and mean DBI score (-0.02 [-0.04, -0.01]) decreased. PIMs and DBI score were associated with increased risks (adjusted odds ratio [95% confidence interval]) of falls (PIMs 1.63 [1.28, 2.08]; DBI score 1.21[1.00, 1.46]) and delirium (PIMs 1.76 [1.38, 1.46]; DBI score 1.42 [1.19, 1.71]). Each measure was associated with increased risk of adverse drug reactions (polypharmacy 1.42 [1.19, 1.71]; PIMs 1.87 [1.40, 2.49]; DBI score 1.90 [1.55, 2.15]). Cost (AU$/patient/hospital day) of medications contributing to PIMs and DBI was low ($0.29 and $0.88).
In this large cohort of older inpatients, usual hospital care results in an increase in number of medications and small reductions in PIMs and DBI, with variable associations with adverse outcomes.
Established new retrospective inpatient cohort of 2000 adults aged ≥75 years, consecutively admitted to 6 hospitals in Sydney, Australia, with detailed information on medications, clinical characteristics and outcomes. Conducted cross-sectional analyses of index admission data from cohort.
Cohort had mean (standard deviation) age 86.0 (5.8) years, 59% female, 21% from residential aged care. On admission, prevalence of polypharmacy was 77%, PIMs 34% and DBI > 0 in 53%. From admission to discharge, mean difference (95% confidence interval) in total number of medications increased 1.05 (0.92, 1.18); while prevalence of exposure to PIMs (-3.8% [-5.4, -2.1]) and mean DBI score (-0.02 [-0.04, -0.01]) decreased. PIMs and DBI score were associated with increased risks (adjusted odds ratio [95% confidence interval]) of falls (PIMs 1.63 [1.28, 2.08]; DBI score 1.21[1.00, 1.46]) and delirium (PIMs 1.76 [1.38, 1.46]; DBI score 1.42 [1.19, 1.71]). Each measure was associated with increased risk of adverse drug reactions (polypharmacy 1.42 [1.19, 1.71]; PIMs 1.87 [1.40, 2.49]; DBI score 1.90 [1.55, 2.15]). Cost (AU$/patient/hospital day) of medications contributing to PIMs and DBI was low ($0.29 and $0.88).
In this large cohort of older inpatients, usual hospital care results in an increase in number of medications and small reductions in PIMs and DBI, with variable associations with adverse outcomes.
摘要：
目的：全面调查住院老年人在常规治疗中的处方：多重用药；根据Beers标准的潜在不适当药物（PIMs）；以及根据药物负担指数（DBI）计算的抗胆碱能和镇静药物累积暴露。具体来说,为了量化入院时对这些措施的暴露，入院和出院之间的变化，与不良结局和药物费用的关联。
方法：建立了2000名年龄≥75岁成年人的新的回顾性住院队列，连续入住悉尼的6家医院，澳大利亚,关于药物的详细信息，临床特征和结果。对来自队列的指标入院数据进行横断面分析。
结果：队列的平均（标准偏差）年龄为86.0（5.8）年，59%女性,21%来自住宅老年护理。一入场,多重用药的患病率为77%，PIMs34%和DBI>0的53%。从入院到出院，药物治疗总数的平均差(95%置信区间)增加1.05(0.92,1.18);而PIMs暴露患病率(-3.8%[-5.4,-2.1])和平均DBI评分(-0.02[-0.04,-0.01])降低.PIMs和DBI评分与跌倒(PIMs1.63[1.28,2.08];DBI评分1.21[1.00,1.46])和谵妄(PIMs1.76[1.38,1.46];DBI评分1.42[1.19,1.71])风险增加(调整后比值比[95%置信区间])相关。各项指标均与药物不良反应风险增加相关（复方1.42[1.19,1.71]；PIMs1.87[1.40,2.49]；DBI评分1.90[1.55,2.15]）。导致PIM和DBI的药物成本（AU$/患者/医院日）较低（$0.29和$0.88）。
结论：在这一庞大的老年住院患者队列中，通常的医院护理导致药物数量的增加和PIMs和DBI的少量减少，与不良结果有可变的关联。
方法：建立了2000名年龄≥75岁成年人的新的回顾性住院队列，连续入住悉尼的6家医院，澳大利亚,关于药物的详细信息，临床特征和结果。对来自队列的指标入院数据进行横断面分析。
结果：队列的平均（标准偏差）年龄为86.0（5.8）年，59%女性,21%来自住宅老年护理。一入场,多重用药的患病率为77%，PIMs34%和DBI>0的53%。从入院到出院，药物治疗总数的平均差(95%置信区间)增加1.05(0.92,1.18);而PIMs暴露患病率(-3.8%[-5.4,-2.1])和平均DBI评分(-0.02[-0.04,-0.01])降低.PIMs和DBI评分与跌倒(PIMs1.63[1.28,2.08];DBI评分1.21[1.00,1.46])和谵妄(PIMs1.76[1.38,1.46];DBI评分1.42[1.19,1.71])风险增加(调整后比值比[95%置信区间])相关。各项指标均与药物不良反应风险增加相关（复方1.42[1.19,1.71]；PIMs1.87[1.40,2.49]；DBI评分1.90[1.55,2.15]）。导致PIM和DBI的药物成本（AU$/患者/医院日）较低（$0.29和$0.88）。
结论：在这一庞大的老年住院患者队列中，通常的医院护理导致药物数量的增加和PIMs和DBI的少量减少，与不良结果有可变的关联。
