請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/56784
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 蕭斐元(Fei-Yuan Hsiao) | |
dc.contributor.author | Wan-Hsuan Lu | en |
dc.contributor.author | 呂宛璇 | zh_TW |
dc.date.accessioned | 2021-06-16T05:48:16Z | - |
dc.date.available | 2019-10-15 | |
dc.date.copyright | 2014-10-15 | |
dc.date.issued | 2014 | |
dc.date.submitted | 2014-08-08 | |
dc.identifier.citation | 1. 行政院衛生福利部:10年來65歲以上國人健保醫療利用情形(引用日期:2014/5/25,網址:http://www.tsim.org.tw/board/246.files/246-9.html#one).
2. Sergi G, De Rui M, Sarti S, Manzato E. Polypharmacy in the elderly: can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging 2011;28:509-18. 3. Beier MT. Updated 2012 Beers Criteria: what's noteworthy and cautionary? Journal of the American Medical Directors Association 2012;13:768-9. 4. Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007;370:173-84. 5. Sorensen L, Stokes JA, Purdie DM, Woodward M, Roberts MS. Medication management at home: medication-related risk factors associated with poor health outcomes. Age Ageing 2005;34:626-32. 6. Jano E, Aparasu RR. Healthcare outcomes associated with beers' criteria: a systematic review. The Annals of pharmacotherapy 2007;41:438-47. 7. American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60:616-31. 8. O’Mahony D, Gallagher P, Ryan C, et al. STOPP & START criteria: A new approach to detecting potentially inappropriate prescribing in old age. European Geriatric Medicine 2010;1:45-51. 9. Chang CB, Yang SY, Lai HY, et al. Using published criteria to develop a list of potentially inappropriate medications for elderly patients in Taiwan. Pharmacoepidemiology and drug safety 2012;21:1269-79. 10. Hanlon JT, Fillenbaum GG, Kuchibhatla M, et al. Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders. Medical care 2002;40:166-76. 11. Pozzi C, Lapi F, Mazzaglia G, et al. Is suboptimal prescribing a risk factor for poor health outcomes in community-dwelling elders? The ICARe Dicomano study. Pharmacoepidemiology and drug safety 2010;19:954-60. 12. Espino DV, Bazaldua OV, Palmer RF, et al. Suboptimal Medication Use and Mortality in an Older Adult Community-Based Cohort: Results From the Hispanic EPESE Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2006;61:170-5. 13. Jyrkka J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Polypharmacy status as an indicator of mortality in an elderly population. Drugs and Aging 2009;26:1039-48. 14. Richardson K, Ananou A, Lafortune L, Brayne C, Matthews FE. Variation over time in the association between polypharmacy and mortality in the older population. Drugs and Aging 2011;28:547-60. 15. Sumukadas D, McMurdo ME, Mangoni AA, Guthrie B. Temporal trends in anticholinergic medication prescription in older people: repeated cross-sectional analysis of population prescribing data. Age Ageing 2013. 16. Franchi C, Tettamanti M, Pasina L, et al. Changes in drug prescribing to Italian community-dwelling elderly people: the EPIFARM-Elderly Project 2000-2010. European journal of clinical pharmacology 2014;70:437-43. 17. Hovstadius B, Hovstadius K, Astrand B, Petersson G. Increasing polypharmacy - an individual-based study of the Swedish population 2005-2008. BMC clinical pharmacology 2010;10:16. 18. Hamilton HJ, Gallagher PF, O'Mahony D. Inappropriate prescribing and adverse drug events in older people. BMC geriatrics 2009;9:5. 19. Hanlon JT, Schmader KE, Ruby CM, Weinberger M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc 2001;49:200-9. 20. Fulton MM, Allen ER. Polypharmacy in the elderly: a literature review. Journal of the American Academy of Nurse Practitioners 2005;17:123-32. 21. Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. Journal of clinical epidemiology 2012;65:989-95. 22. Ziere G, Dieleman JP, Hofman A, Pols HA, van der Cammen TJ, Stricker BH. Polypharmacy and falls in the middle age and elderly population. British journal of clinical pharmacology 2006;61:218-23. 23. Lai SW, Liao KF, Liao CC, Muo CH, Liu CS, Sung FC. Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine 2010;89:295-9. 24. Alarcon T, Barcena A, Gonzalez-Montalvo JI, Penalosa C, Salgado A. Factors predictive of outcome on admission to an acute geriatric ward. Age Ageing 1999;28:429-32. 25. Iwata M, Kuzuya M, Kitagawa Y, Suzuki Y, Iguchi A. Underappreciated predictors for postdischarge mortality in acute hospitalized oldest-old patients. Gerontology 2006;52:92-8. 26. Guaraldo L, Cano FG, Damasceno GS, Rozenfeld S. Inappropriate medication use among the elderly: a systematic review of administrative databases. BMC geriatrics 2011;11:79. 27. Chang CB, Chan DC. Comparison of published explicit criteria for potentially inappropriate medications in older adults. Drugs Aging 2010;27:947-57. 28. Somers A, Mallet L, van der Cammen T, Robays H, Petrovic M. Applicability of an adapted medication appropriateness index for detection of drug-related problems in geriatric inpatients. The American journal of geriatric pharmacotherapy 2012;10:101-9. 29. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Archives of internal medicine 2003;163:2716-24. 30. Lai HY, Hwang SJ, Chen YC, Chen TJ, Lin MH, Chen LK. Prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients covered by the Taiwanese National Health Insurance program. Clinical therapeutics 2009;31:1859-70. 31. Fick DM, Mion LC, Beers MH, J LW. Health outcomes associated with potentially inappropriate medication use in older adults. Research in nursing & health 2008;31:42-51. 32. Zuckerman IH, Langenberg P, Baumgarten M, et al. Inappropriate drug use and risk of transition to nursing homes among community-dwelling older adults. Medical care 2006;44:722-30. 33. Maio V, Yuen EJ, Novielli K, Smith KD, Louis DZ. Potentially inappropriate medication prescribing for elderly outpatients in Emilia Romagna, Italy: a population-based cohort study. Drugs Aging 2006;23:915-24. 34. Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. Journal of the Royal Society of Medicine 2000;93:457-62. 35. Chatterjee S, Mehta S, Sherer JT, Aparasu RR. Prevalence and predictors of anticholinergic medication use in elderly nursing home residents with dementia: analysis of data from the 2004 National Nursing Home Survey. Drugs Aging 2010;27:987-97. 36. Bhattacharya R, Chatterjee S, Carnahan RM, Aparasu RR. Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia. The American journal of geriatric pharmacotherapy 2011;9:434-41. 37. Feinberg M. The problems of anticholinergic adverse effects in older patients. Drugs Aging 1993;3:335-48. 38. Rudd KM, Raehl CL, Bond CA, Abbruscato TJ, Stenhouse AC. Methods for assessing drug-related anticholinergic activity. Pharmacotherapy 2005;25:1592-601. 39. Lertxundi U, Domingo-Echaburu S, Hernandez R, Peral J, Medrano J. Expert-based drug lists to measure anticholinergic burden: similar names, different results. Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society 2013;13:17-24. 40. Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Archives of internal medicine 2008;168:508-13. 41. Lee EK, Lee YJ. Prescription patterns of anticholinergic agents and their associated factors in Korean elderly patients with dementia. International Journal of Clinical Pharmacy 2013;35:711-8. 42. West T, Pruchnicki MC, Porter K, Emptage R. Evaluation of anticholinergic burden of medications in older adults. Journal of the American Pharmacists Association 2013;53:496. 43. Sura SD, Carnahan RM, Chen H, Aparasu RR. Prevalence and determinants of anticholinergic medication use in elderly dementia patients. Drugs Aging 2013;30:837-44. 44. Koyama A, Steinman M, Ensrud K, Hillier TA, Yaffe K. Ten-year trajectory of potentially inappropriate medications in very old women: importance of cognitive status. Journal of the American Geriatrics Society 2013;61:258-63. 45. Yeh YC, Liu CL, Peng LN, Lin MH, Chen LK. Potential benefits of reducing medication-related anticholinergic burden for demented older adults: a prospective cohort study. Geriatrics & gerontology international 2013;13:694-700. 46. Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc 2011;59:1477-83. 47. Han L, Agostini JV, Allore HG. Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. J Am Geriatr Soc 2008;56:2203-10. 48. Narbey D, Jolly D, Mahmoudi R, et al. Relationship between anticholinergic drug use and one-year outcome among elderly people hospitalised in medical wards via emergency department: the SAFES cohort study. The journal of nutrition, health & aging 2013;17:766-71. 49. Uusvaara J, Pitkala KH, Kautiainen H, Tilvis RS, Strandberg TE. Association of anticholinergic drugs with hospitalization and mortality among older cardiovascular patients: A prospective study. Drugs Aging 2011;28:131-8. 50. Veehof L, Stewart R, Haaijer-Ruskamp F, Jong BM. The development of polypharmacy. A longitudinal study. Family practice 2000;17:261-7. 51. Lapi F, Pozzi C, Mazzaglia G, et al. Epidemiology of suboptimal prescribing in older, community dwellers: a two-wave, population-based survey in Dicomano, Italy. Drugs Aging 2009;26:1029-38. 52. 中央健保署:重大傷病範圍(100/3/25修正版本)(引用日期:2013/4/23,網址:http://www.nhi.gov.tw/webdata/webdata.aspx?menu=18&menu_id=683&webdata_id=3471&WD_ID=760). 53. Chow GC. Tests of equality between sets of coefficients in two linear regressions. Econometrica: Journal of the Econometric Society 1960:591-605. 54. Silwer L, Lundborg CS. Patterns of drug use during a 15 year period: data from a Swedish county, 1988--2002. Pharmacoepidemiology and drug safety 2005;14:813-20. 55. Chang CB, Lai HY, Yang SY, et al. Patient- and Clinic Visit-Related Factors Associated with Potentially Inappropriate Medication Use among Older Home Healthcare Service Recipients. PloS one 2014;9:e94350. 56. Chang CB, Chen JH, Wen CJ, et al. Potentially inappropriate medications in geriatric outpatients with polypharmacy: application of six sets of published explicit criteria. British journal of clinical pharmacology 2011;72:482-9. 57. 行政院衛生福利部:101年國人主要死因統計結果(引用日期:2013/5/25,網址:http://www.mohw.gov.tw/CHT/Ministry/DM2_P.aspx?f_list_no=7&fod_list_no=3914&doc_no=28706). 58. Nobili A, Franchi C, Pasina L, et al. Drug utilization and polypharmacy in an Italian elderly population: the EPIFARM-elderly project. Pharmacoepidemiology and drug safety 2011;20:488-96. 59. Pugh MJ, Fincke BG, Bierman AS, et al. Potentially inappropriate prescribing in elderly veterans: are we using the wrong drug, wrong dose, or wrong duration? J Am Geriatr Soc 2005;53:1282-9. 60. Holmes HM, Hayley D, Alexander G, Sachs GA. REconsidering medication appropriateness for patients late in life. Archives of internal medicine 2006;166:605-9. 61. O'Mahony D, O'Connor MN. Pharmacotherapy at the end-of-life. Age and Ageing 2011;40:419-22. 62. Osterberg L, Blaschke T. Adherence to medication. The New England journal of medicine 2005;353:487-97. 63. Carbonin P, Pahor M, Bernabei R, Sgadari A. Is age an independent risk factor of adverse drug reactions in hospitalized medical patients? J Am Geriatr Soc 1991;39:1093-9. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/56784 | - |
dc.description.abstract | 研究背景─
舉凡多重用藥、潛在性不適當用藥與抗膽鹼用藥負荷等老年人用藥問題,尚未被證實會增加死亡與住院等長期不良結果的風險。綜觀過去文獻,因多數研究採用橫斷性設計,也未能考量用藥隨時間變動的特性以及老年族群的異質性,而這些因素可能會影響用藥問題與長期不良結果相關性的判讀。 研究目的─ 分析不同年齡與性別之老年族群,其多重用藥、潛在性不適當用藥與抗膽鹼用藥負荷的長期趨勢(10年),並且在考量用藥問題隨時間變化的影響下,探討其與不良結果之相關性。 研究方法─ 本研究為一回溯性世代研究,利用台灣健保資料庫2000年百萬人承保歸人檔,篩選於2001年1月1日年滿65歲的門診病人,並依年齡分成「65-74歲」、「75-84歲」、「85歲以上」等三組。首先會蒐集研究對象於2001年度之門診就診與用藥問題概況作為背景資料,之後以每三個月一季為單位,分析研究對象在2002年至2011年間每季之用藥變化和不良結果,總計共40季。多重用藥定義為使用五種藥品以上,潛在性不適當用藥會分別以2012年版本之Beers criteria和PIM-TAIWAN評估,抗膽鹼用藥負荷則是依據Anticholinergic Risk Scale (ARS);所分析之不良結果包含死亡、全部住院事件與骨折相關之住院事件。在描述性分析部分,本研究將探討不同年齡組別與性別的用藥趨勢差異,並以Wilcoxon rank-sum test與Chow test檢定之;在不良結果部分,則會使用廣義估計方程式(generalized estimating equations, GEEs),分析各季用藥問題對不良結果的影響。 研究結果─ 本研究共納入59042位老年人,其中年齡為65-74歲占66.7%, 75-84歲與85歲以上者分別占28.6%和4.7%。於追蹤起始時,研究對象平均每年就診22次,平均每季使用3.12種藥品;多重用藥占整體樣本約28%,潛在性不適當用藥分別占45% (Beers criteria 2012)和20% (PIM-TAIWAN),約12.6%老年人使用一種以上具抗膽鹼作用的藥品,ARS分數平均為0.27分。經過十年追蹤後,整體研究對象的年就診次數平均增加了4.5次,每季用藥約增加2.05種;多重用藥、潛在性不適當用藥與抗膽鹼用藥負荷等問題皆有增加的情形。 追蹤起始時以75-84歲族群的就診次數與用藥總數最多,而十年期間以65-74歲族群的用藥數與用藥問題比例增加最多。多重用藥與抗膽鹼用藥負荷在三組中皆有上升趨勢,然而潛在性不適當用藥在85歲以上族群卻呈現減少使用的情形。 不論多重用藥、潛在性不適當用藥與抗膽鹼用藥負荷,與死亡事件皆未呈現正相關性,但會顯著增加住院風險(5-9 drugs: OR=1.56(95% CI: 1.54-1.59);10+ drugs: OR=2.83(95% CI: 2.76-2.89); PIM-Beers: OR=1.53(95% CI: 1.51-1.55); PIM-Taiwan: OR=1.41(95% CI: 1.39-1.43); ARS≥1: OR=1.70(95% CI: 1.67-1.73))。骨折相關之住院事件與各種用藥問題也呈現顯著相關性。 研究結論─ 本研究觀察到不同年齡層之老年族群,其使用門診資源與藥品的情形有顯著差異,因此建議用藥評估時不宜視作同一族群概括討論。多重用藥、潛在性不適當用藥及抗膽鹼用藥負荷顯示與住院事件有相關性,但對於是否會增加死亡風險仍需更多研究佐證。 | zh_TW |
dc.description.abstract | Background:
Suboptimal medication use, included the problems of polypharmacy, potentially inappropriate medication (PIM) and anticholinergic burden, is an important issue in the elderly. Nevertheless, the association with long-term health-related outcomes is still controversial. Also, few studies exist on the longitudinal changes of suboptimal medication use among the older adults in Taiwan. Objectives: The objectives of this study were to investigate longitudinal changes of polypharmacy, PIM and anticholinergic burden in the elderly over a 10-year period, and to examine the association with risk of mortality and risk of hospitalization, according to different age and gender. Methods: Using Taiwan’s National Health Insurance Research Database (NHIRD), outpatients who aged 65 years old and older in 2001 were identified and divided into three groups (aged 65-74, 75-84 and 85+). The ambulatory care and drug utilization of the study subject were collected at baseline in 2001. And then the changes of drug use from baseline were measured every three months from 2002 to 2011 (40 quarters totally). Drug utilization included polypharmacy (concomitant 5 or more drugs), PIM (according to 2012 Beers criteria and PIM-TAIWAN criteria) and anticholinergic burden (according to Anticholinergic Risk Scale, ARS). Adverse outcomes included mortality, all-cause hospitalization and fracture-specific hospitalization. The Wilcoxon rank-sum test, Kruskal-Wallis test and Chow test were used to examine the patterns of drug use between different age groups and gender. Generalized estimating equations (GEEs) was used to examine the association between drug utilization and adverse outcomes. Results: We identified 59,042 older adults (aged 65-74: 66.7%; aged 75-84: 28.6%; aged 85+: 4.7%). At baseline, the average number of visits was about 22 times (per year) and the average number of medications was 3.12 (per quarter) in each study subject. The incidence of polypharmacy was 28% among the population. About 45% and 20% older adults used PIMs recommended by 2012 Beers criteria and PIM-TAIWAN. And 12.6% older adults used at least one anticholinergic agents, with 0.27 points of ARS in average. After ten years observation, about 4.5 time increase in ambulatory visits and 2.05 drugs increase among the population. The patterns of drug utilization were different between age groups. Aged 75-84 had the highest ambulatory care utilization and drug consumption at baseline; however, the highest increase of drug use was found in aged 65-74 over ten years. While the incidence of polypharmacy and anticholinergic burden raised among the aged groups, the use of PIMs declined in aged 85+ during ten years. The negative association with mortality was found in the elderly for polypharmacy, PIM and anticholinergic burden. The associations between all-cause hospitalization and polypharmacy, PIM or anticholinergic burden were significant, after adjusting age, sex and baseline comorbidities (5-9 drugs: OR=1.56(95% CI: 1.54-1.59);10+ drugs: OR=2.83(95% CI: 2.76-2.89); PIM-Beers: OR=1.53(95% CI: 1.51-1.55); PIM-Taiwan: OR=1.41(95% CI: 1.39-1.43); ARS≥1: OR=1.70(95% CI: 1.67-1.73)). The association remained significant when it focused on fracture-specific hospitalization. Conclusion: The trend of polypharmacy, PIM and anticholinergic burden in the elderly increased over the past ten years. Different drug utilization were found in different elderly populations according to age and gender. These were significant association with hospitalization but remained unclear with mortality. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T05:48:16Z (GMT). No. of bitstreams: 1 ntu-103-R01451008-1.pdf: 1861122 bytes, checksum: 7c363ed2a3f47c5d185d33c53e989dc5 (MD5) Previous issue date: 2014 | en |
dc.description.tableofcontents | 中文摘要 i
Abstract iii 目錄 v 表目錄 vii 圖目錄 viii 第1章 緒論 1 第一節 研究背景 1 第二節 研究目的 2 第2章 文獻回顧 3 第一節 老年人用藥問題常見指標 3 第二節 老年人用藥問題與長期不良結果文獻回顧 7 第3章 研究方法 14 第一節 研究材料 14 第二節 研究設計 14 第三節 研究架構與研究變項 18 第四節 統計分析 22 第4章 研究結果 23 第一節 樣本基本特質描述 23 第二節 追蹤期間用藥變化 27 第三節 追蹤期間不良結果發生情形 35 第四節 用藥問題與不良結果之相關性 37 第5章 討論 42 第一節 用藥問題趨勢分析 42 第二節 用藥問題趨勢在不同年齡、性別的差異 45 第三節 用藥問題與不良結果之相關性分析 47 第6章 研究優點與限制 51 第一節 研究特色 51 第二節 研究限制 51 第7章 結論與建議 53 附錄 54 參考文獻 62 | |
dc.language.iso | zh-TW | |
dc.title | 老年人多重用藥、潛在性不適當用藥與抗膽鹼用藥負荷之長期趨勢及相關不良結果 | zh_TW |
dc.title | Polypharmacy, Potentially Inappropriate Medication and Anticholinergic Burden in the Elderly: Longitudinal Changes and Associated Clinical Outcomes | en |
dc.type | Thesis | |
dc.date.schoolyear | 102-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 陳亮恭(Liang-Kung Chen),詹鼎正(Ding-Cheng Chan),溫有汶(Yu-Wen Wen) | |
dc.subject.keyword | 老年人用藥問題,多重用藥,潛在性不適當用藥,抗膽鹼用藥負荷,死亡,住院,骨折, | zh_TW |
dc.subject.keyword | Suboptimal medication use,polypharmacy,potentially inappropriate medication,anticholinergic burden,mortality,hospitalization,fracture, | en |
dc.relation.page | 65 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2014-08-11 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-103-1.pdf 目前未授權公開取用 | 1.82 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。