American Journal Geriatric Pharmacotherapy最新文献_第2页

Medication Discrepancy and Potentially Inappropriate Medication in Older Chinese-American Home-Care Patients After Hospital Discharge 老年美籍华人家庭护理患者出院后用药差异及可能的不当用药

American Journal Geriatric Pharmacotherapy

Pub Date : 2012-10-01 DOI: 10.1016/j.amjopharm.2012.08.001

Sophia H. Hu PhD, RN , Elizabeth Capezuti PhD, RN, FAAN , Janice B. Foust PhD, RN , Marie P. Boltz PhD, RN, GNP-BC , Hongsoo Kim PhD, MPH, RN

Background

Studies of potential medication problems among older adults have focused on English-speaking populations in a single health care setting or a single potential medication problem. No previous studies investigated potential inappropriate medications (PIMs) and medication discrepancies (MDs) among older Chinese Americans during care transitions from hospital discharge to home care.

Objective

The aims of this study were to examine, in older Chinese Americans, the prevalence of both PIMs and MDs; the relationship between PIMs and MDs; and the patient and hospitalization characteristics associated with them during care transitions from hospital discharge to home care.

Methods

This cross-sectional study was conducted with a sample of older Chinese Americans from a large certified nonprofit home-care agency in New York City from June 2010 to July 2011. PIMs were identified by using 2002 diagnosis-independent Beers criteria. MDs were identified by comparing the differences between hospital discharge medication order and home-care admission medication order. Prevalence of PIMs and MDs and their relationship was determined. Logistic regression examined the relationship between hospitalization and patient characteristics with PIMs and MDs.

Results

The sample consisted of 82 older Chinese-American home-care patients. Twenty (24.3%) study participants were prescribed at least one PIM at hospital discharge. Fifty-one (67.1%) study participants experienced at least one MD. A positive correlation was found between the occurrence of PIMs and MDs (r = 0.22; P = 0.05). Number of medications was the only significant factor associated with both PIMs and MDs. In addition, older age and more hospitalization days were associated with PIMs.

Conclusions

The evident prevalence of PIMs and MDs supports the practice of evaluating the appropriateness of medications while reconciling inconsistencies in medication regimens. The number of medications was the only factor associated with both PIMs and MDs, underscoring the need to address polypharmacy as a multifaceted threat to patient health.

背景:对老年人潜在药物问题的研究主要集中在单一医疗保健环境或单一潜在药物问题的英语人群中。以前没有研究调查老年华裔美国人从出院到家庭护理过渡期间潜在的不适当药物(PIMs)和药物差异(MDs)。目的:本研究的目的是检查老年华裔美国人pim和md的患病率;pim与MDs的关系;以及病人和住院特征在从出院到家庭护理的过渡过程中与之相关的。方法本横断面研究于2010年6月至2011年7月在纽约市一家大型认证的非营利性家庭护理机构进行。pim是通过使用2002年独立诊断的Beers标准来确定的。通过比较出院用药顺序与家庭护理住院用药顺序的差异来识别MDs。确定PIMs与MDs的患病率及其关系。Logistic回归分析了住院与pim和MDs患者特征之间的关系。结果样本包括82名老年美籍华人家庭护理患者。20名(24.3%)研究参与者在出院时至少服用了一种PIM。51名(67.1%)研究参与者至少经历过一次MD。PIMs的发生与MD呈正相关(r = 0.22;P = 0.05)。药物数量是与PIMs和MDs相关的唯一显著因素。此外，年龄越大和住院天数越多与pim有关。结论pim和md的明显流行支持了评估药物适当性的实践，同时也调和了用药方案的不一致性。药物数量是与PIMs和md相关的唯一因素，强调有必要将多种用药作为对患者健康的多方面威胁加以解决。

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引用次数: 34

The Effect of Statins on Acute and Long-Term Outcome After Ischemic Stroke in the Elderly 他汀类药物对老年人缺血性脑卒中急性和长期预后的影响

American Journal Geriatric Pharmacotherapy

Pub Date : 2012-10-01 DOI: 10.1016/j.amjopharm.2012.09.001

Clara Hjalmarsson PhD , Lena Bokemark PhD , Karin Manhem PhD , Kirsten Mehlig PhD , Björn Andersson PhD

Background

Although treatment with statins has produced beneficial effects when used as secondary prevention, its primary protective role is still somewhat controversial. Moreover, few studies have evaluated the effect of statins in older patients with stroke.

Objective

The aim was to investigate whether treatment with statins decreases stroke severity and/or improves survival and outcome after stroke in an older population.

Methods

We investigated the association between previous statin use and stroke severity (National Institutes of Health Stroke Scale [NIHSS]), as well as the effect of poststroke statin treatment on 12-month functional outcome (modified Rankin Scale [mRS] score) in 799 patients (mean age, 78 years), with acute ischemic stroke. The effect of statin treatment on survival was examined using the Cox proportional hazard model, after adjusting for relevant covariates.

Results

Statins did not decrease stroke severity and did not improve 30-day survival. However, both the 12-month survival (hazard ratio = 0.33; 95% CI, 0.20–to 0.54; P < 0.001) and the 12-month functional outcome (odds ratio = 2.09; 95% CI, 1.25–3.52; P = 0.005) were significantly better in the group treated with statins.

Conclusions

Significantly better survival and functional outcome were noted with poststroke statins at the end of the 12-month follow-up period. Statins seem to provide beneficial effects for the long-term functional outcome and survival in the elderly.

虽然他汀类药物治疗作为二级预防已经产生了有益的效果，但其主要保护作用仍然存在一些争议。此外，很少有研究评估他汀类药物对老年卒中患者的影响。目的:研究他汀类药物治疗是否能降低老年人群中风后的严重程度和/或改善生存和预后。方法研究799例急性缺血性脑卒中患者(平均年龄78岁)既往使用他汀类药物与脑卒中严重程度(美国国立卫生研究院卒中量表[NIHSS])的关系，以及脑卒中后他汀类药物治疗对12个月功能结局(改良Rankin量表[mRS]评分)的影响。在校正相关协变量后，使用Cox比例风险模型检查他汀类药物治疗对生存率的影响。结果他汀类药物没有降低卒中严重程度，也没有提高30天生存率。然而，12个月生存率(风险比= 0.33;95% CI, 0.20 ~ 0.54;P & lt;0.001)和12个月功能结局(优势比= 2.09;95% ci, 1.25-3.52;P = 0.005)，他汀类药物治疗组明显优于对照组。结论:在12个月的随访期结束时，中风后他汀类药物的生存率和功能预后显著提高。他汀类药物似乎对老年人的长期功能结局和生存有有益的影响。

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引用次数: 18

Pharmacist- Versus Physician-Initiated Admission Medication Reconciliation: Impact on Adverse Drug Events 药剂师与医生发起的入院药物和解:对药物不良事件的影响

American Journal Geriatric Pharmacotherapy

Pub Date : 2012-08-01 DOI: 10.1016/j.amjopharm.2012.06.001

Kari A. Mergenhagen PharmD , Sharon S. Blum PharmD , Anne Kugler PharmD , Elayne E. Livote PhD , Jonathan R. Nebeker MS, MD , Michael C. Ott PharmD , Daniel Signor BA , Soojin Sung PharmD , Jessica Yeh PharmD , Kenneth S. Boockvar MD, MS

Background

Medication reconciliation (MR) has proven to be a problematic task for many hospitals to accomplish. It is important to know the clinical impact of physician- versus pharmacist-initiated MR in the resource-limited hospital environment.

Methods

This quasi-experimental study took place from December 2005 to February 2006 at an urban US Veterans Affairs hospital. MR was implemented on 2 similar general medical units: one received physician-initiated MR and the other received pharmacist-initiated MR. Adverse drug events (ADEs) and a 72-hour medication-prescribing risk score were ascertained by research pharmacists for all admitted patients by structured record review. Multivariable models were tested for intervention effect, accounting for quasi-experimental design and clustered observations, and were adjusted for patient and encounter covariates.

Results

Pharmacists completed the MR process in 102 admissions and physicians completed the process in 116 admissions. In completing the MR process, pharmacists documented statistically more admission medication changes than physicians (3.6 vs 0.8; P < 0.001). The adjusted odds of an ADE caused by an admission prescribing change with pharmacist-initiated MR compared with a physician-initiated MR were 1.04 with a 95% CI of 0.53 to 2.0. The adjusted odds of an ADE caused by an admission prescribing change that was a prescribing error with pharmacist-initiated MR compared with a physician-initiated MR were 0.38 with a confidence interval of 0.14 to 1.05. No difference was observed in 72-hour prescribing risk score (coefficient = 0.10; 95% CI, −0.54 to 0.75).

Conclusion

MR performed by pharmacists versus physicians was more comprehensive and was followed by lower odds of ADEs from admission prescribing errors but with similar odds of all types of ADEs. Further research is warranted to examine how MR tasks may be optimally divided among clinicians and the mechanisms by which MR affects the likelihood of subsequent ADEs. ClinicalTrials.gov identifier: NCT00370916.

药物和解(MR)已被证明是许多医院难以完成的任务。在资源有限的医院环境中，了解医生与药剂师发起的磁共振的临床影响是很重要的。方法本研究于2005年12月至2006年2月在美国一家城市退伍军人事务医院进行。在2个类似的普通医疗单位实施MR:一个接受医生发起的MR，另一个接受药剂师发起的MR，研究药师通过结构化记录回顾确定所有住院患者的药物不良事件(ADEs)和72小时用药风险评分。对多变量模型进行干预效果检验，考虑准实验设计和聚类观察，并对患者和遭遇协变量进行调整。结果102例住院患者中药师完成磁共振检查，116例住院患者中内科医生完成磁共振检查。在完成MR过程中，药剂师记录的入院药物变化统计上多于医生(3.6 vs 0.8;P & lt;0.001)。与内科医生发起的MR相比，由药剂师发起的MR引起的入院处方改变导致ADE的调整几率为1.04,95% CI为0.53至2.0。由药剂师发起的MR与医生发起的MR相比，由处方错误引起的入院处方变更引起ADE的调整几率为0.38，置信区间为0.14至1.05。72小时处方风险评分差异无统计学意义(系数= 0.10;95% CI，−0.54 ~ 0.75)。结论与内科医生相比，药师进行的磁共振检查更全面，因入院处方错误而发生不良事件的几率更低，但所有类型的不良事件的几率相似。有必要进一步研究如何在临床医生之间最佳地分配MR任务，以及MR影响后续ade可能性的机制。ClinicalTrials.gov识别码:NCT00370916。

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引用次数: 58

The Impact of Family Caregivers on Potentially Inappropriate Medication Use in Noninstitutionalized Older Adults With Dementia 家庭照顾者对非机构老年痴呆患者潜在不适当用药的影响

American Journal Geriatric Pharmacotherapy

Pub Date : 2012-08-01 DOI: 10.1016/j.amjopharm.2012.05.001

Joshua M. Thorpe PhD, MPH , Carolyn T. Thorpe PhD, MPH , Korey A. Kennelty PharmD, MS , Walid F. Gellad MD, MPH , Richard Schulz PhD

Background

The risk of potentially inappropriate medication (PIM), both prescription and over-the-counter, use in dementia patients is high. Informal caregivers often facilitate patients' use of medications, but the effect of caregiver factors on PIM use has not been a focus of previous research.

Objective

The aim of this study was to examine PIM use in dementia patients and caregivers and identify caregiver risk factors for PIM use in dementia patients.

Methods

We conducted a secondary data analysis of the baseline wave of the Resources for Enhancing Alzheimer's Caregiver's Health study. The sample comprised 566 persons with dementia aged 65 and older and their coresiding family caregiver. PIM was defined using the 2003 Beers criteria and was examined in both dementia patients and their caregivers. Caregiver and patient risk factors included a range of sociodemographic and health variables.

Results

In dementia patients, 33% were taking at least 1 PIM, and 39% of their caregivers were also taking a PIM. In fully adjusted models, the following caregiver factors were associated with an increased risk of dementia patient PIM use: caregiver's own PIM use, spouse caregivers, Hispanic caregivers, and greater number of years that the caregiver has lived in the United States. Increased caregiver age was associated with a decreased risk of PIM use in patients.

Conclusions

PIM use may be higher in dementia patients and their informal caregivers compared with the general older adult population. Further, patterns of medication use in 1 member of the dyad may influence PIM risk in the other dyad member. These results suggest that interventions to increase appropriate medication use in dementia patients and their caregivers should target both members of the dyad and target over-the-counter agents along with prescription medications.

背景:在痴呆患者中使用潜在不适当药物(PIM)的风险很高，无论是处方药还是非处方药。非正式护理人员往往促进患者使用药物，但护理人员因素对PIM使用的影响并不是以往研究的重点。目的本研究的目的是检查痴呆患者和护理者使用PIM的情况，并确定痴呆患者使用PIM的护理者危险因素。方法:我们对增强阿尔茨海默氏症护理者健康资源研究的基线波进行了二次数据分析。样本包括566名65岁及以上的痴呆症患者和他们共同居住的家庭照顾者。PIM是使用2003年Beers标准定义的，并在痴呆患者及其护理人员中进行了检查。照顾者和患者的风险因素包括一系列社会人口和健康变量。结果33%的痴呆患者至少服用1次PIM, 39%的痴呆患者的护理人员同时服用PIM。在完全调整的模型中，以下照顾者因素与痴呆患者使用PIM的风险增加有关:照顾者自己使用PIM，配偶照顾者，西班牙裔照顾者，以及照顾者在美国居住的年数。护理人员年龄的增加与患者使用PIM的风险降低有关。结论与一般老年人群相比，痴呆患者及其非正式照护者对spim的使用可能更高。此外，二组中一个成员的药物使用模式可能会影响另一个成员的PIM风险。这些结果表明，在痴呆患者及其护理人员中增加适当药物使用的干预措施应该针对这对夫妇中的成员，并针对非处方药和处方药。

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引用次数: 64

FDA Drug Safety Communications: A Narrative Review and Clinical Considerations for Older Adults FDA药物安全通讯:对老年人的叙述回顾和临床考虑

American Journal Geriatric Pharmacotherapy

Pub Date : 2012-08-01 DOI: 10.1016/j.amjopharm.2012.05.002

Zachary A. Marcum PharmD, MS , Joseph P. Vande Griend PharmD , Sunny A. Linnebur PharmD

Background

The US Food and Drug Administration (FDA) has new regulatory authorities intended to enhance drug safety monitoring in the postmarketing period. This has resulted in an increase in communication from the FDA in recent years about the safety profile of certain drugs. It is important to stay abreast of the current literature on drug risks to effectively communicate these risks to patients, other health care providers, and the general public.

Objective

To summarize 4 new FDA drug safety communications by describing the evidence supporting the risks and the clinical implications for older adults.

Methods

The FDA Web site was reviewed for new drug safety communications from May 2011 to April 2012 that would be relevant to older adults. Approved labeling for each drug or class was obtained from the manufacturer, and PubMed was searched for primary literature that supported the drug safety concern.

Results

FDA drug safety communications for 4 drugs were chosen because of the potential clinical importance in older adults. A warning for citalopram was made because of potential problems with QT prolongation in patients taking less than 40 mg per day. The evidence suggests minor changes in QT interval. Given the flat dose–response curve in treating depression with citalopram, the new 20-mg/d maximum dose in older adults is sensible. Another warning was made for proton pump inhibitors (PPIs) and an increased risk of Clostridium difficile infection. A dose–response relationship was found for this drug risk. With C. difficile infections on the rise in older adults, along with other safety risks of PPI therapy, PPIs should only be used in older adults indicated for therapy for the shortest duration possible. In addition, a warning about dabigatran was made. There is strong evidence from a large clinical trial, as well as case reports, of increased bleeding risk in older adults taking dabigatran, especially in older adults with decreased renal function. This medication should be used with caution in older adults. Finally, several warnings were made about statins. Routine periodic monitoring of liver enzymes does not appear to be effective in detecting or preventing serious liver injury from statin use; thus, liver enzymes are no longer recommended to be routinely monitored. Statin-induced cognitive changes are rare, and insufficient evidence is currently available to establish causality. Statins appear to moderately increase the risk of developing diabetes (versus placebo), and regular screening for diabetes should be considered, especially for patients taking high-dose statins and patients with multiple risk factors for diabetes.

Conclusion

FDA drug safety communications incorporate complex

美国食品和药物管理局(FDA)有了新的监管机构，旨在加强上市后期间的药物安全监测。这导致近年来FDA就某些药物的安全性进行了越来越多的沟通。重要的是要及时了解当前关于药物风险的文献，以便有效地将这些风险传达给患者、其他卫生保健提供者和公众。目的总结4种新的FDA药品安全通报，描述支持风险的证据及其对老年人的临床意义。方法对FDA网站2011年5月至2012年4月期间与老年人相关的新药安全信息进行审查。从制造商处获得每种药物或类别的批准标签，并在PubMed上搜索支持药物安全问题的主要文献。结果4种药物的fda药品安全沟通是基于对老年人潜在的临床重要性而选择的。对西酞普兰提出警告，因为每天服用少于40毫克的患者存在QT间期延长的潜在问题。有证据表明QT间期有轻微变化。考虑到西酞普兰治疗抑郁症的平坦剂量-反应曲线，老年人新的20mg /d最大剂量是合理的。另一个警告是质子泵抑制剂(PPIs)和艰难梭菌感染风险增加。这种药物风险存在剂量-反应关系。随着老年人艰难梭菌感染的增加，以及PPI治疗的其他安全风险，PPI应仅用于指征治疗的老年人，持续时间尽可能短。此外，还对达比加群进行了警告。一项大型临床试验和病例报告强有力地证明，服用达比加群的老年人出血风险增加，尤其是肾功能下降的老年人。老年人应谨慎使用这种药物。最后，对他汀类药物提出了一些警告。肝酶的常规定期监测似乎不能有效地发现或预防他汀类药物使用引起的严重肝损伤;因此，不再建议常规监测肝酶。他汀类药物引起的认知改变是罕见的，目前没有足够的证据来确定因果关系。他汀类药物似乎会适度增加患糖尿病的风险(与安慰剂相比)，应考虑定期进行糖尿病筛查，特别是服用高剂量他汀类药物的患者和患有多种糖尿病危险因素的患者。结论fda药物安全沟通采用复杂的方法来调查药物治疗的风险(和相对收益)。照顾老年人的临床医生需要了解这些药物风险背后的最新证据，以便与患者有效沟通和护理。

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引用次数: 69

Looking Beyond Polypharmacy: Quantification of Medication Regimen Complexity in the Elderly 超越多种用药:老年人用药方案复杂性的量化

American Journal Geriatric Pharmacotherapy

Pub Date : 2012-08-01 DOI: 10.1016/j.amjopharm.2012.06.002

Nariman Mansur PharmMs , Avraham Weiss MD , Yichayaou Beloosesky MD

Background

Polypharmacy has been shown to influence outcomes in elderly patients. However, the impact of medication regimen complexity, quantified by the Medication Regimen Complexity Index (MRCI), on health outcomes after discharge of elderly patients has not been studied.

Objective

Our aim was to test the convergent, discriminant, and predictive validity of the MRCI in older hospitalized patients with varying functional and cognitive levels.

Methods

We retrospectively applied the MRCI to the medication regimen of 212 hospitalized patients and assessed its validity.

Results

The mean (SD) MRCI scores for medication regimens and number of medications at discharge were 30.27 (13.95) and 5.95 (2.40), respectively. The MRCI scores were strongly correlated with the number of medications (r = 0.94, P < 0.001) and the number of daily doses (r = 0.87, P < 0.001) and increased as the number of medications taken ≥3 times daily increased (27.35, 34.45, and 43.00 for none, 1, and 2 drugs, respectively; P < 0.001). Positive correlations were observed between the Cumulative Illness Rating Scale–Geriatrics score and both the number of medications and the MRCI score (r = 0.40, r = 0.46, P < 0.001, respectively). No relationship was found between MRCI scores and the number of medications and age, sex, and postdischarge medication modifications. Patients nonadherent to at least 1 drug were discharged with a higher MRCI score and higher number of medications compared with medication-compliant patients (33.3 and 7.0 vs 27 and 5.8, respectively; P < 0.01). An inverse correlation was found between overall adherence 1 month after discharge and the MRCI score (r = −0.188, P = 0.028); however, no such correlation was found regarding the number of medications at discharge.

Conclusions

The MRCI showed satisfactory validity and good evidence of classifying regimen complexity over a simple medication count. The MRCI demonstrated application in clinical research and practice in the elderly. However, more studies are needed to investigate its advantage over the number of medications for identifying patients with complex medication regimens and directing interventions to simplify their medication regimen complexity.

背景:多种药物治疗已被证明会影响老年患者的预后。然而，用药方案复杂性指数(MRCI)量化的用药方案复杂性对老年患者出院后健康结局的影响尚未得到研究。目的:我们的目的是检验MRCI在不同功能和认知水平的老年住院患者中的收敛性、判别性和预测性有效性。方法回顾性分析212例住院患者的用药方案，并对其有效性进行评价。结果两组患者用药方案和出院用药次数的平均(SD) MRCI评分分别为30.27(13.95)和5.95(2.40)。MRCI评分与用药次数密切相关(r = 0.94, P <0.001)和每日剂量数(r = 0.87, P <0.001)，且随着每日用药次数≥3次的增加而增加(无用药、1用药和2用药分别为27.35、34.45和43.00;P & lt;0.001)。累积疾病评定量表-老年病学评分与用药次数和MRCI评分呈正相关(r = 0.40, r = 0.46, P <分别为0.001)。MRCI评分与用药数量、年龄、性别和出院后用药修改没有关系。与依从药物治疗的患者相比，不依从至少一种药物治疗的患者出院时MRCI评分更高，服药次数也更多(分别为33.3和7.0 vs 27和5.8;P & lt;0.01)。出院后1个月的总体依从性与MRCI评分呈负相关(r = - 0.188, P = 0.028);然而，在出院时服用药物的数量方面没有发现这种相关性。结论磁共振成像显示了令人满意的有效性和较好的证据分类方案的复杂性比简单的药物计数。磁共振成像在老年患者的临床研究和实践中得到了应用。然而，需要更多的研究来调查其在识别复杂用药方案的患者和指导干预以简化其用药方案复杂性方面的优势。

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引用次数: 86

A Year in Review: New Drugs for Older Adults in 2011 一年回顾:2011年老年人新药

American Journal Geriatric Pharmacotherapy

Pub Date : 2012-08-01 DOI: 10.1016/j.amjopharm.2012.05.003

Joseph P. Vande Griend PharmD , Zachary A. Marcum PharmD, MS , Sunny A. Linnebur PharmD

Background

New drugs approved by the Food and Drug Administration (FDA) may offer tremendous clinical advances by providing health care providers with new treatment strategies. However, additional care must be taken for safe and effective use of these new agents by older adults.

Objective

Our objective was to identify FDA-approved medications in 2011 most likely to be prescribed to older adults, and to describe medication characteristics that may require special attention in this population.

Methods

The FDA Web site was reviewed for new drug approvals from January through December 2011. Approved labeling for each drug was obtained from the manufacturer's Web site and PubMed was searched for primary literature published between 1967 and 2012.

Results

Rivaroxaban, an oral factor Xa inhibitor, is approved for once-daily use in treatment of nonvalvular atrial fibrillation and deep vein thrombosis prophylaxis after replacement of a hip or knee. Drug interactions and renal function must be considered when prescribing this drug to older adults. Fidaxomicin is an oral anti-infective approved for the treatment of Clostridium difficile-associated diarrhea. It has minimal oral absorption or side effects, no relevant drug interactions, but a very high cost. It is a treatment option after failure of oral metronidazole and oral vancomycin. Roflumilast is a selective inhibitor of phosphodiesterase 4 and is approved to reduce the risk of chronic obstructive pulmonary disease (COPD) exacerbations in patients with severe COPD and a history of exacerbations. It is recommended as a second or alternative choice combined with a long-acting bronchodilator in patients at high risk for hospitalization. Indacaterol is an inhaled long-acting β-agonist approved for COPD maintenance. It is administered once daily, which may improve adherence in older adults compared with currently available twice-daily agents.

Conclusions

Four new drugs approved in 2011 applicable to the geriatric population are presented. Clinicians must consider the available evidence, cost, drug–drug interactions, renal function, pharmacokinetic/pharmacodynamic differences, and patient preferences when considering prescribing these agents to older adults.

美国食品和药物管理局(FDA)批准的新药可能通过为医疗保健提供者提供新的治疗策略而带来巨大的临床进步。然而，必须格外注意老年人安全有效地使用这些新药。我们的目标是确定2011年fda批准的最可能用于老年人的药物，并描述该人群可能需要特别注意的药物特征。方法从2011年1月至12月对FDA网站上的新药批准进行审查。从制造商的网站上获得了每种药物的批准标签，并在PubMed上检索了1967年至2012年发表的主要文献。利伐沙班是一种口服Xa因子抑制剂，被批准每日一次用于治疗髋关节或膝关节置换术后的非瓣膜性房颤和深静脉血栓预防。在给老年人开此药时，必须考虑药物相互作用和肾功能。非达索霉素是一种口服抗感染药物，被批准用于治疗艰难梭菌相关性腹泻。它的口服吸收或副作用很小，没有相关的药物相互作用，但成本非常高。是口服甲硝唑和万古霉素治疗失败后的一种治疗选择。罗氟米司特是一种选择性磷酸二酯酶4抑制剂，被批准用于降低慢性阻塞性肺疾病(COPD)严重恶化史患者的COPD恶化风险。对于住院风险高的患者，推荐将其与长效支气管扩张剂联合使用作为第二或替代选择。因达卡特罗是一种被批准用于COPD维持的吸入长效β激动剂。它每天给药一次，与目前可用的每天两次的药物相比，这可能提高老年人的依从性。结论2011年获批的适用于老年人群的新药有4种。临床医生在考虑给老年人开这些药物时，必须考虑现有证据、成本、药物-药物相互作用、肾功能、药代动力学/药效学差异和患者偏好。

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引用次数: 4

Anticholinergic Drugs and Functional Outcomes in Older Patients Undergoing Orthopaedic Rehabilitation 老年骨科康复患者的抗胆碱能药物和功能结局

American Journal Geriatric Pharmacotherapy

Pub Date : 2012-08-01 DOI: 10.1016/j.amjopharm.2012.06.003

Sejlo Koshoedo MB, BS , Roy L. Soiza MB ChB , Rajib Purkayastha MB, BS , Arduino A. Mangoni MD, PhD

Background

Medications with anticholinergic (antimuscarinic) effects negatively affect physical and cognitive function in community-dwelling older patients. However, it is unknown if anticholinergic drugs exert detrimental effects in older patients undergoing rehabilitation.

Objective

The purpose of our study was to assess the effect of anticholinergic drug exposure on functional outcomes in older patients undergoing rehabilitation. We speculated that higher anticholinergic drug exposure would be associated with reduced functional outcomes in this group.

Methods

Data on clinical characteristics, full medication, anticholinergic drug exposure (total number of anticholinergic drugs [tAD] and Anticholinergic Risk Scale [ARS] score), and Barthel index (BI) score were collected on admission and discharge in a consecutive series of 117 older patients (age 79 [7] years) admitted to the orthopaedic rehabilitation unit of a teaching hospital between July 2010 and March 2011. Outcome measures were BI changes (BI on discharge – BI on admission) during rehabilitation (primary outcome) and length of stay (secondary outcome).

Results

Anticholinergic drugs were prescribed in 38 patients (32.5%). Median and interquartile range for tAD = 0 (0–1); for ARS = 0 (0–1). Poisson regression showed that higher tAD (incidence rate ratio [IRR] = 0.92; 95% CI, 0.88–0.97; P = 0.003) and ARS scores (IRR = 0.97; 95% CI, 0.95–0.99; P = 0.008) on admission independently predicted lower BI changes. Being a woman (IRR = 0.87; 95% CI, 0.78–0.97; P = 0.01), lower Abbreviated Mental Test scores (IRR = 0.94; 95% CI, 0.91–0.97; P < 0.001), and lower BI on admission (IRR = 0.98; 95% CI, 0.97–0.98; P < 0.001), but not tAD or ARS scores, independently predicted increasing length of stay.

Conclusions

Higher anticholinergic drug exposure on admission independently predicts reduced functional outcomes, but not length of stay, in older patients undergoing orthopaedic rehabilitation.

背景:具有抗胆碱能作用的药物会对社区老年患者的身体和认知功能产生负面影响。然而，目前尚不清楚抗胆碱能药物是否对接受康复治疗的老年患者有不利影响。目的研究抗胆碱能药物暴露对老年康复患者功能结局的影响。我们推测，较高的抗胆碱能药物暴露与该组功能结果降低有关。MethodsData临床特点,完整的药物,抗胆碱能药物暴露(抗胆碱能药物总数(少量)和抗胆碱能风险规模(ARS)的分数),和Barthel指数(BI)得分收集117年一系列连续的入院和出院老年患者(79岁[7]年)承认的骨科康复单元教学医院2010年7月至2011年3月。结果措施BI变化对放电(BI - BI入院时)在康复期间(主要结果)和滞留时间(二次结果)。ResultsAnticholinergic药物被规定在38例(32.5%)。tAD = 0(0 - 1)的中位数和四分位数范围;对于ARS = 0(0 - 1)。泊松回归显示，较高的tAD(发病率比[IRR] = 0.92;95% ci, 0.88-0.97;P = 0.003)和ARS评分(IRR = 0.97;95% ci, 0.95-0.99;P = 0.008)独立预测较低的BI变化。作为一个女人(IRR = 0.87;95% ci, 0.78-0.97;P = 0.01)，较低的简略智力测验分数(IRR = 0.94;95% ci, 0.91-0.97;P & lt;0.001),并降低BI入院时(IRR = 0.98;95%置信区间,0.97 - -0.98;P & lt;0.001)，但tAD或ARS评分不能独立预测住院时间的增加。ConclusionsHigher抗胆碱能药物暴露在承认独立预测减少功能的结果,但不是呆的长度,在老年患者接受骨科康复。

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引用次数: 31

Medication Adherence in Older Adults With Cognitive Impairment: A Systematic Evidence-Based Review 老年认知障碍患者的药物依从性:一项系统的循证评价

American Journal Geriatric Pharmacotherapy

Pub Date : 2012-06-01 DOI: 10.1016/j.amjopharm.2012.04.004

Noll L. Campbell PharmD , Malaz A. Boustani MD, MPH , Elaine N. Skopelja MALS, AHIP , Sujuan Gao PhD , Fred W. Unverzagt PhD , Michael D. Murray PharmD, MPH

Background

Cognitive impairment challenges the ability to adhere to the complex medication regimens needed to treat multiple medical problems in older adults.

Objective

Our aim was to conduct a systematic evidence-based review to identify barriers to medication adherence in cognitively impaired older adults and interventions aimed at improving medication adherence.

Methods

A search of MEDLINE, EMBASE, PsycINFO, GoogleDocs, and CINAHL for articles published between 1966 and February 29, 2012 was performed. Studies included older adults with a diagnosis of cognitive impairment of any degree (mild cognitive impairment or mild, moderate, or severe dementia). To identify barriers to adherence, we reviewed observational studies. To identify relevant interventions, we reviewed clinical trials targeting medication adherence in cognitively impaired older adults. We excluded studies lacking a measure of medication adherence or lacking an assessment of cognitive function, case reports or series, reviews, and those focusing on psychiatric disorders or infectious diseases. Population demographics, baseline cognitive function, medication adherence methods, barriers to adherence, and prospective intervention methodologies were extracted.

Results

The initial search identified 594 articles. Ten studies met inclusion criteria for barriers to adherence and three met inclusion criteria for interventional studies. Unique barriers to adherence included understanding new directions, living alone, scheduling medication administration into the daily routine, using potentially inappropriate medications, and uncooperative patients. Two studies evaluated reminder systems and showed no benefit in a small group of participants. One study improved adherence through telephone and televideo reminders at each dosing interval. The results of the review are limited by reviewing only published articles, missing barriers or interventions due to lack of subgroup analysis, study selection and extraction completed by 1 reviewer, and articles with at least an abstract published in English.

Conclusions

The few studies identified limit the assessment of barriers to medication adherence in the cognitively impaired population. Successful interventions suggest that frequent human communication as reminder systems are more likely to improve adherence than nonhuman reminders.

背景认知障碍挑战了老年人坚持治疗多种医学问题所需的复杂药物治疗方案的能力。我们的目的是进行一项系统的循证评价，以确定认知障碍老年人药物依从性的障碍和旨在改善药物依从性的干预措施。方法在MEDLINE、EMBASE、PsycINFO、GoogleDocs、CINAHL等数据库中检索1966年至2012年2月29日发表的论文。研究包括诊断为任何程度认知障碍(轻度认知障碍或轻度、中度或重度痴呆)的老年人。为了确定依从性障碍，我们回顾了观察性研究。为了确定相关的干预措施，我们回顾了针对认知障碍老年人药物依从性的临床试验。我们排除了缺乏药物依从性测量或缺乏认知功能评估、病例报告或系列、综述以及专注于精神疾病或传染病的研究。提取了人口统计数据、基线认知功能、药物依从性方法、依从性障碍和前瞻性干预方法。最初的搜索确定了594篇文章。10项研究符合依从性障碍的纳入标准，3项研究符合介入性研究的纳入标准。坚持治疗的独特障碍包括理解新的方向、独自生活、将药物管理安排到日常生活中、使用可能不适当的药物以及不合作的患者。两项评估提醒系统的研究显示，在一小部分参与者中没有任何益处。一项研究通过电话和电视提醒在每次给药间隔提高依从性。由于只纳入了已发表的文章，缺少亚组分析，缺少由1位审稿人完成的研究选择和提取，缺少障碍或干预措施，以及至少有一篇英文摘要发表的文章，本综述的结果受到限制。结论少数研究限制了对认知障碍人群药物依从性障碍的评估。成功的干预表明，频繁的人际沟通作为提醒系统比非人类提醒更有可能提高依从性。

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引用次数: 189

Case Report: Post–Traumatic Memories Triggered by Donepezil in a Dose-Dependent Pattern 病例报告:多奈哌齐剂量依赖性引发创伤后记忆

American Journal Geriatric Pharmacotherapy

Pub Date : 2012-06-01 DOI: 10.1016/j.amjopharm.2012.03.001

Michael L. Wolff MD

Background

This case report describes a new adverse drug event due to use of donepezil in a patient with probable Alzheimer's Disease.

Case summary

While receiving a 10-mg dose of donepezil nightly, an 87-year old veteran of World War II experienced irrepressible memories of a kamikaze strike. This symptom did not occur at a 5-mg dose of donepezil and resolved with downward titration of this agent.

Conclusions

This sequence of dosage and symptoms suggests acetylcholinesterase inhibition was the trigger for release of these memories, which are otherwise mostly chronically repressed in this individual.

本病例报告描述了一个新的药物不良事件，由于使用多奈哌齐患者可能患有阿尔茨海默病。一位87岁的二战老兵在每晚服用10毫克的多奈哌齐后，对神风特攻队的袭击产生了难以抑制的记忆。5毫克剂量的多奈哌齐没有出现这种症状，并随着该药的下降滴度而消失。结论:这种剂量和症状的顺序表明乙酰胆碱酯酶抑制是这些记忆释放的触发因素，否则这些记忆在该个体中大多被慢性抑制。

引用次数: 5

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