老人用藥適當性之現況與展望

藥物是老人健康照護最常見的治療措施，為了治療急慢性病，維持目前健康、預防進一步的衰退、延長存活時間和提高生活品質，正確使用藥物對老人健康照護是非常重要的（de Oliveira Alves, Schuelter-Trevisol, & Trevisol, 2014）。1991年由Beers醫師等人提出潛在不適當用藥（potentially inappropriate medication, PIM）概念迄今已將近30年，世界各國學者也陸續發表明確列舉式準則以供臨床與研究使用，身為老人照護第一線醫療人員，更應加強詢問和瞭解老人的藥品狀況，釐清老人目前服用這些藥品的適應症及藥品訴求或目的，熟悉並善用藥品適當性評估工具，以協助醫療團隊有效率地找出老人PIM，做為老人與醫療團隊之間溝通的橋樑。由系統性文獻回顧發現，隨著研究樣本、研究場所及評估工具的不同，老人PIM使用之盛行率約3.6%–92.0%（Nothelle, Sharma, Oakes, Jackson, & Segal, 2017; Redston, Hilmer, McLachlan, Clough, & Gnjidic, 2018; Storms, Marquet, Aertgeerts, & Claes, 2017）。在臺灣老人PIM使用之盛行率則為9.8%–91.2%（沈，2008；黃、葉、洪、謝、蔡，2011；Chang et al., 2011; Lin, Peng, Chen, Lin, & Hwang, 2011），顯示臺灣老人PIM使用的問題嚴重性並不亞於歐美各國。 Medication is the most common strategy for addressing the healthcare needs of older adults. In order to treat disease, maintain health, prevent further declines in health, prolong survival, and improve quality of life, the proper use of medicine is of great importance in the care of older patients (de Oliveira Alves, Schuelter-Trevisol, & Trevisol, 2014). Since the physician Dr. Beers put forward the concept of potentially inappropriate medication (PIM) almost thirty years ago in 1991 (Beers et al., 1991), scholars around the world have issued explicit criteria related to PIM for clinical and research purposes. It is necessary for the first-line medical personnel who are involved in caring for older patients to increase their knowledge and understanding of the medication status of their older patients, clarify the indications of medicines taken by these patients, and become familiar with the tools used to assess the appropriateness of medications in order to assist the medical team to identify PIM and to serve as a channel between older patients and the medical team.