| Objective:To understand the characteristics and regularity of adverse drug reactions(ADR)in the elderly.To investigate the characteristics and related factors of chronic diseases and polypharmacy in elderly patients.To analyze the potentially inappropriate medications(PIM)and their related factors of elderly outpatient prescriptions.Summarize the preventive measures and provide references on drug treatments in the elderly.Methods:(1)ADR reports of the elderly patients in the Army Adverse Drug Reaction Monitoring Center database from 2009 to 2016 were collected.Combining with literature research,we identified the types of chronic diseases in polypharmacy research.(2)According to the range of diseases screened,the prescription informations of 13175 outpatients in HIS database were collected and analyzed retrospectively to have a preliminary understanding of polypharmacy and related factors in the elderly.(3)Based on Chinese criteria,Beers criteria and STOPP criteria,a retrospective study was conducted to compare the potentially inappropriate drug treatments of 13175 outpatients.Result:(1)In the ADR elderly reports of 41176 cases,the serious ADR reports were 3144 cases(7.64%),the most common ADR were caused by ani-infective drugs(9830,23.87%)and cancer drugs(4601,11.17%),the main varieties were levofloxacin,moxifloxacin,oxaliplatin,gemcitabine,docetaxel and so on.Serious ADR were bone marrow suppression(495,0.96%)and anaphylactic shock(241,0.46%),the main drugs were gemcitabine,docetaxel,moxifloxacin and so on.The frequency of elderly chronic diseases was followed by coronary atherosclerotic heart disease,tumor,hypertension,diabetes,pulmonary infection,and cerebral infarction.(2)In 13175 elderly patients,the proportion of polypharmacy was 22.98%.Among them,8205(62.28%)elderly patients had multiple chronic diseases.The frequency of suffering diseases was followed by hypertension,coronary heart disease,tumors/cancers,etc.Polypharmacy showed more comorbidity:hypertension+coronary heart disease and hypertension+coronary heart disease+diabetes.Comorbidity of 2 diseases and visiting doctors more than 2 times were independent risk factors for polypharmacy(P<0.05).(3)In 13175 elderly patients,the number of elderly PIM screening cases were:Chinese criteria 2415(18.33%),Beers criteria 2475(18.79%),and STOPP criteria 406(3.08%).The common drugs for PIM in the elderly were clopidogrel,isosorbide mononitrate,aspirin,and estazolam etc.The evaluation results between Chinese criteria and Beers criteria were consistent(P<0.05);Other inappropriate prescriptions were not included in the criteria which was 13.11%.The common unsuitable type of prescription was 12.02%with incorrect prescription dose usage.Among them,there were 122 kinds of chemical drugs and 51 kinds of proprietary Chinese patent medicines.Aged>80 years old,comorbid diseases>2,drug types>5 kinds,etc.were independent risk factors for elderly PIM(P<0.05).Conclusion:In this study,through the retrospective analysis of 41176 elderly patients with ADR reports,the occurrence and characteristics of ADR in the elderly were obtained.The screening identified the types of chronic diseases associated with potentially inappropriate drugs.Furthermore,an empirical analysis of 13175 cases of large-scale prescription drugs for outpatients in the elderly was conducted to explore the correlations between chronic diseases and polypharmacy,and to provide clinical evidence for drug treatments in the elderly.According to the comparative analysis results of prescriptions based on three different PIM criteria,the elderly patients with age>80 years old,combined diseases>2,and drug types>5 should be observed.This study compared the similarities and differences between Chinese criteria,Beers criteria and STOPP criteria for PIM evaluation and found that isosorbide mononitrate,metoprolol,zopiclone,alendronate,and proprietary Chinese patent medicines were not included in Chinese criteria,to provide a reliable reference on the revision of Chinese criteria. |
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