Prevalence and influencing factors of potentially inappropriate medication in elderly outpatients: analysis of 34 886 cases

Xin ZHANG; Lin CHENG; Peishu FU; Qing DAI; Yongchuan CHEN

doi:10.16016/j.1000-5404.202105057

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Prevalence and influencing factors of potentially inappropriate medication in elderly outpatients: analysis of 34 886 cases

Clinical Medicine | 更新时间：2026-02-13

- Prevalence and influencing factors of potentially inappropriate medication in elderly outpatients: analysis of 34 886 cases
- Journal of Third Military Medical University Vol. 43, Issue 20, Pages: 2260-2265(2021)
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院药学部
- 作者简介：
- 基金信息：
  
  Supported by the Joint General Program of Chongqing Science and Technology Commission and Chongqing Health Commission(2021MSXM218)
- DOI：10.16016/j.1000-5404.202105057
  CLC： R181.35;R339.34;R969.3
- Received：14 May 2021，
  
  Revised：2021-07-05，
  
  Published：30 October 2021
- 稿件说明：
移动端阅览
Xin ZHANG, Lin CHENG, Peishu FU, et al. Prevalence and influencing factors of potentially inappropriate medication in elderly outpatients: analysis of 34 886 cases[J]. Journal of Third Military Medical University, 2021, 43(20): 2260-2265.
DOI：

Xin ZHANG, Lin CHENG, Peishu FU, et al. Prevalence and influencing factors of potentially inappropriate medication in elderly outpatients: analysis of 34 886 cases[J]. Journal of Third Military Medical University, 2021, 43(20): 2260-2265. DOI： 10.16016/j.1000-5404.202105057.

摘要

目的

回顾性分析门诊老年患者潜在不适当用药(potentially inappropriate medication，PIM)情况及其影响因素，以提高门诊老年患者合理用药水平。

方法

选取2019年11月1日至2019年12月31日我院门诊部就诊的老年患者(≥65岁)，以Beers标准(2019版) 为依据，分析门诊老年患者PIM发生情况，采用多因素Logistic回归分析PIM的影响因素。

结果

纳入分析的处方案例共34 886例，男性17 162例，女性17 724例，年龄(72.55±6.53)岁，患病种数(2.56±1.65)种，用药品种数(3.34±2.03)种。根据Beers标准(2019版)，PIM的发生率为16.4% (5 721/34 886)，其中5 721例患者存在PIM共6 958项，占比在前3位的药物为复方降压药(19.09%，1 328/6 958)、磺酰脲类降糖药(11.27%，784/6 958)、苯二氮艹卓类药物(10.82%，753/6 958)。PIM主要分布于神经内科、老年病科、内分泌科、心血管内科和中医风湿科。Logistic回归分析显示，年龄≥75岁、用药种数≥5种、疾病种数5~9种以及处方中含复方制剂是门诊老年患者发生PIM的独立危险因素(

0.001)。

结论

门诊老年患者PIM发生率较高，PIM现状仍有待改进，用药品种数多是PIM最重要的危险因素，临床医师及药师应予以重视。

Abstract

Objective

To retrospectively analyze potential inappropriate medication (PIM) and its influencing factors among elderly outpatients in order to improve the rational drug use for them.

Methods

The elderly outpatients (≥65 years old) admitted in our hospital from November 1 to December 30

2019 were enrolled in this study. Their PIMs were evaluated according to the Beers Criteria of the American Geriatric Association 2019. Multivariate logistic regression analysis was used to analyze the influencing factors of PIM.

Results

he prescriptions of 34 886 cases were collected in the analysis. They were 17 162 males and 17 724 females

at an age of 72.55±6.53 years

and had a number of comorbidities of 2.56±1.65 and took 3.34±2.03 kinds of drugs for each patient. According to the 2019 Beers criteria

the incidence of PIM was 16.4% (5 721/34 886)

involving 6 958 times of PIM in 5 721 cases. The top 3 drugs were compound hypotensor (19.09%

1 328/6 958)

sulfonylureas (11.27%

784/6 958) and benzodiazepines (10.82%

753/6 958). The PIM incidence distributed in the departments of neurology

geriatrics

endocrinology

cardiology and traditional medicine and rheumatology. Logistic regression analysis showed that age (≥75 years)

number of medications (≥5)

number of comorbidities (5~9) and prescriptions containing compound preparations were independent risk factors for PIM (

0.001).

Conclusion

According to the 2019 Beers criteria

the incidence of PIM is relatively high in elderly outpatients

so rational drug use needs to be improved in clinical practice. Combination of various drugs is the most important risk factors of PIM

and should be paid attention by clinicians and pharmacists.

关键词

Keywords

references

MUHLACK D C, HOPPE L K, WEBERPALS J, et al . The association of potentially inappropriate medication at older age with cardiovascular events and overall mortality: a systematic review and meta-analysis of cohort studies[J ] . J Am Med Dir Assoc, 2017, 18(3): 211-220. DOI: 10.1016/j.jamda.2016.11.025.

BEERS M H, OUSLANDER J G, ROLLINGHER I, et al . Explicit criteria for determining inappropriate medication usein nursing home residents. UCLA Division of Geriatric Medicine[J ] . Arch Intern Med, 1991, 151(9): 1825-1832. DOI: 10.1001/archinte.1991.00400090107019.

GARCIA R M. Five ways You can reduce inappropriate prescribing in the elderly: a systematic review[J]. J Fam Pract, 2006, 55(4): 305-312.

KAUFMANN C P, TREMP R, HERSBERGER K E, et al . Inappropriate prescribing: a systematic overview of published assessment tools[J ] . Eur J Clin Pharmacol, 2014, 70(1): 1-11. DOI: 10.1007/s00228-013-1575-8.

By The 2019 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults[J]. J Am Geriatr Soc, 2015, 63(11): 2227-2246. DOI: 10.1111/jgs.13702.

By The American Geriatrics Society Beers Criteria ® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers criteria ® for potentially inappropriate medication use in older adults[J ] . J Am Geriatr Soc, 2019, 67(4): 674-694. DOI: 10.1111/jgs.15767..

林桂锋, 王玉紫, 邓思韵. Beers标准评价门诊老年患者潜在不适当用药[J]. 中国处方药, 2016, 14(3): 23-24. DOI: 10.3969/j.issn.1671-945X.2016.03.016.

LIN G F, WANG Y Z, DENG S Y. Evaluation using Beers criteria on potentially inappropriate medication in elderly outpatients[J]. J China Prescr Drug, 2016, 14(3): 23-24. DOI: 10.3969/j.issn.1671-945X.2016.03.016.

林宝丽, 苏银法, 胡国新. Beers标准评价我院门诊老年患者潜在性不适当用药[J]. 药物流行病学杂志, 2014, 23(7): 431-432, 436.

LIN B L, SU Y F, HU G X. Evaluation of potentially inappropriate medication among elderly outpatients by beers criteria[J]. Chin J Pharmacoepidemiol, 2014, 23(7): 431-432, 436.

陈智, 苏银法, 胡国新. 门诊内科老年患者潜在性不适当用药影响因素的回顾性分析[J]. 药物流行病学杂志, 2016, 25(4): 247-250.

CHEN Z, SU Y F, HU G X. Analysis of influencing factors of potentially inappropriate medication in elderly outpatients based on beers criteria[J]. Chin J Pharmacoepidemiol, 2016, 25(4): 247-250.

梁华玉, 张兰, 邢晓璇, 等. 中国六城市门急诊老年患者潜在不适当用药情况及影响因素分析[J]. 药物不良反应杂志, 2017, 19(1): 22-30. DOI: 10.3760/cma.j.issn.1008-5734.2017.01.006.

LIANG H Y, ZHANG L, XING X X, et al . Analysis on prevalence and influencing factors of potentially inappropriate medication in elderly patients in outpatient and emergency departments inChina[J ] . Adverse Drug React J, 2 017, 19(1): 22-30. DOI: 10.3760/cma.j.issn.1008-5734.2017.01.006.

张莹, 田方圆, 李海霞, 等. 成都市老年门诊患者潜在不适当用药评估及风险因素分析[J]. 中国药师, 2021, 24(6): 1117-1122.

ZHANG Y, TIAN F Y, LI H X, et al . Potentialinappropriate medication and risk factor analysis in elderly outpatients in Chengdu[J ] . China Pharmacist, 2021, 24(6): 1117-1122.

MANDAVI, D'CRUZ S, SACHDEV A, et al . Prevalence and risk factors for inappropriate drug use among older people: results from an Indian public outpatient setting[J ] . J Pharm Heal Serv Res, 2011, 2(1): 29-34. DOI: 10.1111/j.1759-8893.2010.00028.x.

ZAVERI H G, MANSURI S M, PATEL V J. Use of potentially inappropriate medicines in elderly: a prospective study in medicine out-patient department of a tertiary care teaching hospital[J]. Indian J Pharmacol, 2010, 42(2): 95-98. DOI: 10.4103/0253-7613.64499.

MAIO V, DEL CANALE S, ABOUZAID S, et al . Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study[J ] . J Clin Pharm Ther, 2010, 35(2): 219-229. DOI: 10.1111/j.1365-2710.2009.01094.x.

LIM Y J, KIM H Y, CHOI J, et al . Potentially inappropriate medications by beers criteria in older outpatients: prevalence and risk factors[J ] . Korean J Fam Med, 2016, 37(6): 329-333. DOI: 10.4082/kjfm.2016.37.6.329.

BHATT A N, PAUL S S, KRISHNAMOORTHY S, et al . Potentially inappropriate medications prescribed for older persons: A study from two teaching hospitalsin Southern India[J ] . J Fam Community Med, 2019, 26(3): 187-192. DOI: 10.4103/jfcm.JFCM_81_19.

LIAMIS G, FILIPPATOS T D, ELISAF M S. Thiazide-associated hyponatremia in the elderly: what the clinician needs to know[J]. J Geriatr Cardiol, 2016, 13(2): 175-182. DOI: 10.11909/j.issn.1671-5411.2016.02.001.

闻雷雷, 胡素娟, 崔勇. 抗组胺药物及其新药研究进展[J]. 国际皮肤性病学杂志, 2013, 39(1): 72-74. DOI: 10.3760/cma.j.issn.1673-4173.2013.01.025.

WEN L L, HU S J, CUI Y. Update on antihistamines[J]. Int J Dermatol Venereol, 2013, 39(1): 72-74. DOI: 10.3760/cma.j.issn.1673-4173.2013.01.025.

BRETT J, MAUST D T, BOUCK Z, et al . Benzodiazepine use in older adults in the United States, Ontario, and Australia from 2010 to 2016[J ] . J Am Geriatr Soc, 2018, 66(6): 1180-1185. DOI: 10.1111/jgs.15292.

ISLAM M M, IQBAL U, WALTHER B, et al . Benzodiazepine use and risk of dementia in the elderly population: a systematic review and meta-analysis[J ] . Neuroepidemiology, 2016, 47(3/4): 181-191. DOI: 10.1159/000454881.

YU N W, CHEN P J, TSAI H J, et al . Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case-control study in Taiwan[J ] . BMC Geriatr, 2017, 17(1): 140. DOI: 10.1186/s12877-017-0530-4.

中国老年医学学会高血压分会, 国家老年疾病临床医学研究中心, 中国老年心血管病防治联盟. 中国老年高血压管理指南2019[J]. 中华老年多器官疾病杂志, 2019, 18(2): 81-106. DOI: 10.11915/j.issn.1671-5403.2019.02.019.

Hypertension Branch of Chinese Geriatrics Society, National Clinical Medicine Research Center of the Geriatric Diseases, Chinese Association of Prevention and Treatment for the Geriatric Cardiovascular Disease. 2019 CGS guideline on the management of hypertension in the elderly[J]. Chin J Mult Organ Dis Elderly, 2019, 18 (2): 81-106. DOI: 10.11915/j.issn.1671-5403.2019.02.019.

O'MAHONY D, O'SULLIVAN D, BYRNE S, et al . STOPP/START criteria for potentially inappropriate prescribing in older people: version 2[J ] . Age Ageing, 2015, 44(2): 213-218. DOI: 10.1093/ageing/afu145.

中国老年保健医学研究会老年合理用药分会, 中华医学会老年医学分会, 中国药学会老年药学专业委员会, 等. 中国老年人潜在不适当用药判断标准(2017年版)[J]. 药物不良反应杂志, 2018, 20(1): 2-8. DOI: 10.3760/cma.j.issn.1008-5734.2018.01.002.

Rational Drug Use Branch of Chinese Association of Geriatric Research, Geriatrics Branch of Chinese Medical Association, Geriatric Medication Committee of Chinese Pharmaceutical Association, et al . Criteria of potentially inappropriate medications for older adults in China[J ] . Adverse Drug React J, 2018, 20(1): 2-8. DOI: 10.3760/cma.j.issn.1008-5734.2018.01.002.

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