Abstract：
OBJECTIVE: Deprescribing opportunities may differ across health care systems, nursing home settings, and prescribing cultures. The objective of this study was to compare the prevalence of STOPPFrail medications according to frailty status among residents of nursing homes in Australia, China, Japan, and Spain.
METHODS: Secondary cross-sectional analyses of data from 4 cohort studies.
METHODS: A total of 1142 residents in 31 nursing homes.
METHODS: Medication data were extracted from resident records. Frailty was assessed using the FRAIL-NH scale (non-frail 0-2; frail 3-6; most-frail 7-14). Chi-square tests and prevalence ratios (PRs) were used to compare STOPPFrail medication use across cohorts.
RESULTS: In total, 84.7% of non-frail, 95.6% of frail, and 90.6% of most-frail residents received ≥1 STOPPFrail medication. Overall, the most prevalent STOPPFrail medications were antihypertensives (53.0% in China to 73.3% in Australia, P < .001), vitamin D (nil in China to 52.7% in Australia, P < .001), lipid-lowering therapies (11.1% in Japan to 38.9% in Australia, P < .001), aspirin (13.5% in Japan to 26.2% in China, P < .001), proton pump inhibitors (2.1% in Japan to 32.0% in Australia, P < .001), and antidiabetic medications (12.3% in Japan to 23.5% in China, P = .010). Overall use of antihypertensives (PR, 1.15; 95% CI, 1.06-1.25), lipid-lowering therapies (PR, 1.78; 95% CI, 1.45-2.18), aspirin (PR, 1.31; 95% CI, 1.04-1.64), and antidiabetic medications (PR, 1.31; 95% CI, 1.00-1.72) were more prevalent among non-frail and frail residents compared with most-frail residents. Antihypertensive use was more prevalent with increasing frailty in China and Japan, but less prevalent with increasing frailty in Australia. Antidiabetic medication use was less prevalent with increasing frailty in China and Spain but was consistent across frailty groups in Australia and Japan.
CONCLUSIONS: There were overall and frailty-specific variations in prevalence of different STOPPFrail medications across cohorts. This may reflect differences in prescribing cultures, application of clinical practice guidelines in the nursing home setting, and clinician or resident attitudes toward deprescribing.
METHODS: Secondary cross-sectional analyses of data from 4 cohort studies.
METHODS: A total of 1142 residents in 31 nursing homes.
METHODS: Medication data were extracted from resident records. Frailty was assessed using the FRAIL-NH scale (non-frail 0-2; frail 3-6; most-frail 7-14). Chi-square tests and prevalence ratios (PRs) were used to compare STOPPFrail medication use across cohorts.
RESULTS: In total, 84.7% of non-frail, 95.6% of frail, and 90.6% of most-frail residents received ≥1 STOPPFrail medication. Overall, the most prevalent STOPPFrail medications were antihypertensives (53.0% in China to 73.3% in Australia, P < .001), vitamin D (nil in China to 52.7% in Australia, P < .001), lipid-lowering therapies (11.1% in Japan to 38.9% in Australia, P < .001), aspirin (13.5% in Japan to 26.2% in China, P < .001), proton pump inhibitors (2.1% in Japan to 32.0% in Australia, P < .001), and antidiabetic medications (12.3% in Japan to 23.5% in China, P = .010). Overall use of antihypertensives (PR, 1.15; 95% CI, 1.06-1.25), lipid-lowering therapies (PR, 1.78; 95% CI, 1.45-2.18), aspirin (PR, 1.31; 95% CI, 1.04-1.64), and antidiabetic medications (PR, 1.31; 95% CI, 1.00-1.72) were more prevalent among non-frail and frail residents compared with most-frail residents. Antihypertensive use was more prevalent with increasing frailty in China and Japan, but less prevalent with increasing frailty in Australia. Antidiabetic medication use was less prevalent with increasing frailty in China and Spain but was consistent across frailty groups in Australia and Japan.
CONCLUSIONS: There were overall and frailty-specific variations in prevalence of different STOPPFrail medications across cohorts. This may reflect differences in prescribing cultures, application of clinical practice guidelines in the nursing home setting, and clinician or resident attitudes toward deprescribing.
摘要：
目的：各个医疗系统的开药机会可能不同，疗养院设置，和规定文化。这项研究的目的是根据澳大利亚疗养院居民的虚弱状况比较STOPPFrail药物的患病率，中国,Japan,和西班牙。
方法：对4项队列研究的数据进行二级横断面分析。
方法：31所疗养院共1142名居民。
方法：从居民记录中提取用药数据。使用FRAIL-NH量表评估虚弱（非虚弱0-2；虚弱3-6；最虚弱7-14）。卡方检验和患病率比（PR）用于比较队列中的STOPPFrail药物使用情况。
结果：总计，84.7%的非脆弱，95.6％的脆弱，90.6%的最虚弱的居民接受了≥1次STOPPFrail药物治疗。总的来说,最普遍的STOPPFrail药物是抗高血压药（中国为53.0%，澳大利亚为73.3%，P≤.001),维生素D(中国为零，澳大利亚为52.7%，P≤.001),降脂治疗（日本为11.1%，澳大利亚为38.9%，P≤.001),阿司匹林(日本为13.5%，中国为26.2%，P≤.001),质子泵抑制剂（日本为2.1%，澳大利亚为32.0%，P≤.001),和抗糖尿病药物(日本为12.3%，中国为23.5%，P=.010）。整体使用抗高血压药(PR，1.15；95%CI，1.06-1.25），降脂疗法（PR，1.78；95%CI，1.45-2.18），阿司匹林（PR，1.31；95%CI，1.04-1.64），和抗糖尿病药物(PR，1.31;95％CI，1.00-1.72）在非虚弱和虚弱的居民中比大多数虚弱的居民更为普遍。在中国和日本，随着虚弱的增加，抗高血压的使用更加普遍。但随着澳大利亚日益脆弱，这种情况就不那么普遍了。在中国和西班牙，随着虚弱的增加，抗糖尿病药物的使用不那么普遍，但在澳大利亚和日本的虚弱群体中，抗糖尿病药物的使用是一致的。
结论：不同STOPPFrail药物在不同队列中的患病率存在总体和脆弱的特异性差异。这可能反映了处方文化的差异，临床实践指南在疗养院环境中的应用，和临床医生或居民对开药的态度。
方法：对4项队列研究的数据进行二级横断面分析。
方法：31所疗养院共1142名居民。
方法：从居民记录中提取用药数据。使用FRAIL-NH量表评估虚弱（非虚弱0-2；虚弱3-6；最虚弱7-14）。卡方检验和患病率比（PR）用于比较队列中的STOPPFrail药物使用情况。
结果：总计，84.7%的非脆弱，95.6％的脆弱，90.6%的最虚弱的居民接受了≥1次STOPPFrail药物治疗。总的来说,最普遍的STOPPFrail药物是抗高血压药（中国为53.0%，澳大利亚为73.3%，P≤.001),维生素D(中国为零，澳大利亚为52.7%，P≤.001),降脂治疗（日本为11.1%，澳大利亚为38.9%，P≤.001),阿司匹林(日本为13.5%，中国为26.2%，P≤.001),质子泵抑制剂（日本为2.1%，澳大利亚为32.0%，P≤.001),和抗糖尿病药物(日本为12.3%，中国为23.5%，P=.010）。整体使用抗高血压药(PR，1.15；95%CI，1.06-1.25），降脂疗法（PR，1.78；95%CI，1.45-2.18），阿司匹林（PR，1.31；95%CI，1.04-1.64），和抗糖尿病药物(PR，1.31;95％CI，1.00-1.72）在非虚弱和虚弱的居民中比大多数虚弱的居民更为普遍。在中国和日本，随着虚弱的增加，抗高血压的使用更加普遍。但随着澳大利亚日益脆弱，这种情况就不那么普遍了。在中国和西班牙，随着虚弱的增加，抗糖尿病药物的使用不那么普遍，但在澳大利亚和日本的虚弱群体中，抗糖尿病药物的使用是一致的。
结论：不同STOPPFrail药物在不同队列中的患病率存在总体和脆弱的特异性差异。这可能反映了处方文化的差异，临床实践指南在疗养院环境中的应用，和临床医生或居民对开药的态度。
