台灣長者潛在性不適當用藥準則建議與生命末期適用性之探討

Criteria Defining Potentially Inappropriate Medications in Taiwan and Their Applications to End-of-Life

由於醫療與科技的進步，全世界人類預期壽命在這幾年不斷延長。然而隨著人口老化，人類必須要面對許多慢性疾病和相關用藥的問題。緊接而來就出現多重用藥的議題以及許多可能發生的藥物不良反應，因此許多國家發展、設計出不適當用藥準則供臨床使用。第一版台灣不適當用藥準則發表在2012年，於2018年更新為第二版。除了長者潛在不適當用藥問題，近年來生命末期以及安寧病人的不適當用藥問題，因為需考量不同面向，也更受到重視。國際間，已有一些生命末期以及安寧病人適用的潛在不適當用藥準則。然而在第二版的台灣長者不適當用藥準則中，並無相關的觀點或準則。本文將討論世界上常使用的潛在不適當用藥準則、台灣不適當用藥準則前後兩版、生命末期和安寧病人適用的潛在不適當用藥準則以及未來台灣不適當用藥準則的展望。

Global life expectancy has been prolonged due to the advancement of medical research and technology in spite of the continuous existence of chronic and age-related diseases. Polypharmacy and adverse drug reaction have received more increased attention in recent years; and criteria for potentially inappropriate medications (PIM) have been developed in many countries. The PIM-Taiwan criteria had the first edition published in 2012 and the second edition updated in 2018. Apart from the geriatric population, PIM is also an issue of grave concern for patients receiving end-of-life and hospice care as there are different considerations and needs to be addressed. Internationally, there are several PIMs developed especially for end-of-life and hospice patients. However, the second edition of the PIM-Taiwan criteria has not addressed this issue with regards to these special group of people. In the article, we review the PIM criteria commonly used around the world, the two editions of PIM-Taiwan criteria, PIM criteria for end-of-life and hospice care, and the prospects of PIM-Taiwan criteria.