台灣老年人抗膽鹼潛在不適當用藥與不良結果之相關性研究   全文下載

Relationship between Potentially Inappropriate Anticholinergic Drugs (PIADs) and Adverse Outcomes among Elderly Patients in Taiwan

Beers’criteria指出部分抗膽鹼藥物對於老人為不適當用藥，但美國仍有12%~21%的老人持續使用。本研究擬探討台灣老年人抗膽鹼潛在不適當用藥（PIADs）與其可能造成之不良結果的相關性。以國家衛生研究院發行「全民健康保險學術研究資料庫」之2005年100萬人「承保抽樣歸人檔」（LHID2005）為橫斷性資料來源，分析2007年至2008年65歲以上老年病患門診處方。以「抗膽鹼用藥判斷準則」（ARS）做為不適當用藥之判斷標準，不良結果包括急診、住院之不良事件，以及藥物不良反應如便秘、譫妄、心律不整及認知障礙惡化。台灣老年人抗膽鹼潛在不適當用藥之處方盛行率為18.67%，但至少有75.65%的老年人曾經接受過至少一次之抗膽鹼潛在不適當用藥。在控制其他相關影響因素後，發現抗膽鹼潛在不適當用藥者相較於無抗膽鹼潛在不適當用藥者，其急診之相對危險性為1.85倍；住院之相對危險性為1.07倍；此外在發生便秘、譫妄及心律不整等藥物不良反應，亦有較高之相對危險性（OR=1.87、1.51及1.16）。本研究驗證抗膽鹼潛在不適當用藥與不良結果之相關性。建議醫師對於老年病患處方抗膽鹼藥物時，必須更加謹慎，以避免不良結果之機率，並增進老年病患用藥安全。

The Beers’ criteria indicate that some anticholinergic drugs are inappropriate for treating elderly patients, but those most frequently used anticholinergic drugs in previous studies. This study was aimed to explore the association between the potentially inappropriate anticholinergic drugs (PIADs) and adverse outcomes among elderly people in Taiwan. A retrospective cohort study was conducted by analyzing the Longitudinal Health Insurance Database (LHID2005) of the National Health Insurance Research Database (NHIRD) from 2007 to 2008 to investigate all prescriptions for elderly people above the age of 65. The anticholinergic risk scale (ARS) constituted the criteria for PIADs. Adverse outcomes included emergency visits, hospitalization, and adverse drug reactions (ADRs) such as constipation, delirium, cardiac arrhythmia, and cognitive impairment. The prevalence of PIADs was 18.67% in outpatient prescriptions. Approximately 75.65% of outpatients have received at least one PIAD. After adjusting for age, gender, the number of drug items, and CCI, patients, who have received PIADs, had higher risks of emergency visits, hospitalization, constipation, delirium, and cardiac dysrhythmia (odds ratio [OR] = 1.85, 1.07, 1.87, 1.51 and 1.16) than those who have never received PIADs. This study suggests that physicians should be cautious when prescribing anticholinergic drugs for elderly patients to reduce the risk of adverse outcomes and improve the safety of medicating elderly people.