Yue Zhou MSN, YuFan Pan MSN, Yi Xiao MSN, YuJian Sun MSN, Yu Dai MSN, YuFeng Yu MD
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Studies assessing the association between PIM and the risk of death in older adults with sufficient data for meta-analysis were included. Effect sizes were combined using a random-effects model, and heterogeneity was systematically explored.</div></div><div><h3>Results</h3><div>A total of 44 studies involving 2,191,651 older adults were included. The overall PIM incidence was 45.7% (95% CI, 34.5%-57.0%). Meta-analysis revealed a combined odds ratio (OR) of 1.28 (95% CI, 1.20–1.36) for the association between PIM and increased risk of death. In addition, antipsychotics were associated with a higher risk of death (OR, 2.19; 95% CI, 1.75–2.73), as were anticholinergics (OR, 1.52; 95% CI, 1.23–1.88). Subgroup analyses indicated the association between PIM and death risk was particularly significant in Asia and Oceania, with a weaker association in North America and Europe. The strongest associations were found in individuals aged 70 years and older. The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria had stronger associations than other diagnostic criteria for PIM.</div></div><div><h3>Conclusions and Implications</h3><div>This study confirms a significant association between PIM and mortality risk in older adults, highlighting the need for rational medication use. Clinicians should carefully assess medications in treatment plans. 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引用次数: 0
摘要
目的：本研究旨在通过系统回顾和荟萃分析，全面评估老年人潜在不适当用药（PIM）与死亡风险之间的关系。设计：系统回顾和荟萃分析。环境和参与者：60岁及以上使用PIM的成年人。方法：系统检索截至2024年7月23日的PubMed、Web of Science、Cochrane Library、Embase、chinese care and Allied Health Literature Cumulative Index to Nursing （CINAHL）、Scopus和CNKI数据库。纳入了评估PIM与老年人死亡风险之间关系的研究，这些研究有足够的数据进行荟萃分析。使用随机效应模型组合效应大小，并系统地探索异质性。结果：共纳入44项研究，涉及2191651名老年人。PIM总发生率为45.7% （95% CI, 34.5%-57.0%）。荟萃分析显示PIM与死亡风险增加之间的联合优势比（OR）为1.28 （95% CI, 1.20-1.36）。此外，抗精神病药物与较高的死亡风险相关(OR, 2.19；95% CI, 1.75-2.73)，抗胆碱能药物也是如此(OR, 1.52；95% ci, 1.23-1.88)。亚组分析表明，PIM与死亡风险之间的关联在亚洲和大洋洲尤为显著，而在北美和欧洲的关联较弱。在70岁及以上的人群中发现了最强的关联。老年人潜在不当处方筛查工具（STOPP）标准与PIM的其他诊断标准有较强的相关性。结论和意义：本研究证实了PIM与老年人死亡风险之间的显著关联，强调了合理用药的必要性。临床医生应仔细评估治疗方案中的药物。未来的研究应加强评估工具，调查PIM对健康结果的影响，以改善用药管理。
Association between Potentially Inappropriate Medication and Mortality Risk in Older Adults: A Systematic Review and Meta-Analysis
Objectives
This study aimed to comprehensively assess the association between potentially inappropriate medication (PIM) and mortality risk in older adults through systematic review and meta-analysis.
Design
Systematic review and meta-analysis.
Setting and Participants
Adults aged 60 years and older with PIM use.
Methods
A systematic search was conducted in PubMed, Web of Science, Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and China National Knowledge Infrastructure (CNKI) databases up to July 23, 2024. Studies assessing the association between PIM and the risk of death in older adults with sufficient data for meta-analysis were included. Effect sizes were combined using a random-effects model, and heterogeneity was systematically explored.
Results
A total of 44 studies involving 2,191,651 older adults were included. The overall PIM incidence was 45.7% (95% CI, 34.5%-57.0%). Meta-analysis revealed a combined odds ratio (OR) of 1.28 (95% CI, 1.20–1.36) for the association between PIM and increased risk of death. In addition, antipsychotics were associated with a higher risk of death (OR, 2.19; 95% CI, 1.75–2.73), as were anticholinergics (OR, 1.52; 95% CI, 1.23–1.88). Subgroup analyses indicated the association between PIM and death risk was particularly significant in Asia and Oceania, with a weaker association in North America and Europe. The strongest associations were found in individuals aged 70 years and older. The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria had stronger associations than other diagnostic criteria for PIM.
Conclusions and Implications
This study confirms a significant association between PIM and mortality risk in older adults, highlighting the need for rational medication use. Clinicians should carefully assess medications in treatment plans. Future research should enhance assessment tools and investigate the impact of PIM on health outcomes to improve medication management.
期刊介绍：
JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates.
The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality
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