背景:不适当的处方(IP)在住院的有虚弱的老年人中很常见。然而,目前尚不清楚虚弱的存在是否会增加死亡和IP再入院的风险,也不清楚是否纠正IP降低了这种风险.进行这项审查是为了确定IP是否会增加住院的中老年人虚弱的不良结局的风险。
方法:对住院的中年人(45-64岁)和老年人(≥65岁)有虚弱的IP进行了系统评价。这篇综述考虑了多种类型的知识产权,包括潜在的不适当的药物,处方遗漏和药物相互作用。包括观察性和介入性研究。结果为死亡率和再入院。搜索的数据库包括MEDLINE,CINAHL,EMBASE,科学世界,SCOPUS和Cochrane图书馆。搜索更新至2024年7月12日。使用随机效应模型进行荟萃分析以汇集风险估计。
结果:共确定了569项研究,其中7项符合纳入标准,都集中在老年人口。五项观察性研究之一发现,在特定时间点,IP与急诊科就诊和再入院之间存在关联。其中三项观察性研究适用于荟萃分析,结果显示IP与再入院之间无显著关联(OR1.08,95%CI0.90-1.31)。评估Beers标准药物的亚组的荟萃分析表明,此类IP的再入院风险增加了27%(OR1.27,95%CI1.03-1.57)。在两项介入研究的荟萃分析中,与常规治疗相比,干预措施降低了IP,死亡率风险降低了37%(OR0.63,95%CI0.40~1.00),但在再入院方面没有差异(OR0.83,95%CI0.19~3.67).
结论:降低IP的干预措施与降低死亡风险相关,但不是重新接纳,与虚弱的老年人的常规护理相比。在该组中,使用Beers标准药物与再次入院有关。然而,更广泛的IP与死亡率或再入院之间存在关联的证据有限.需要进一步的高质量研究来证实这些发现。
BACKGROUND: Inappropriate prescribing (IP) is common in hospitalised older adults with frailty. However, it is not known whether the presence of frailty confers an increased risk of mortality and readmissions from IP nor whether rectifying IP reduces this risk. This
review was conducted to determine whether IP increases the risk of adverse outcomes in hospitalised middle-aged and older adults with frailty.
METHODS: A systematic
review was conducted on IP in hospitalised middle-aged (45-64 years) and older adults (≥ 65 years) with frailty. This
review considered multiple types of IP including potentially inappropriate medicines, prescribing omissions and drug interactions. Both observational and interventional studies were included. The outcomes were mortality and hospital readmissions. The databases searched included MEDLINE, CINAHL, EMBASE, World of Science, SCOPUS and the Cochrane Library. The search was updated to 12 July 2024. Meta-analysis was performed to pool risk estimates using the random effects model.
RESULTS: A total of 569 studies were identified and seven met the inclusion criteria, all focused on the older population. One of the five observational studies found an association between IP and emergency department visits and readmissions at specific time points. Three of the observational studies were amenable to meta-analysis which showed no significant association between IP and hospital readmissions (OR 1.08, 95% CI 0.90-1.31). Meta-analysis of the subgroup assessing Beers criteria medicines demonstrated that there was a 27% increase in the risk of hospital readmissions (OR 1.27, 95% CI 1.03-1.57) with this type of IP. In meta-analysis of the two interventional studies, there was a 37% reduced risk of mortality (OR 0.63, 95% CI 0.40-1.00) with interventions that reduced IP compared to usual care but no difference in hospital readmissions (OR 0.83, 95% CI 0.19-3.67).
CONCLUSIONS: Interventions to reduce IP were associated with reduced risk of mortality, but not readmissions, compared to usual care in older adults with frailty. The use of Beers criteria medicines was associated with hospital readmissions in this group. However, there was limited evidence of an association between IP more broadly and mortality or hospital readmissions. Further high-quality studies are needed to confirm these findings.