老人潛在不適當用藥之文獻回顧

Review of Potentially Inappropriate Medication in the Elderly

10.6317/LTC.201910_23(2).0001

林香汶(Hsiang-Wen Lin)；賴況潔(Kuang-Chieh Lai)；林志學(Chih-Hsueh Lin)

老人 ； 潛在不適當用藥 ； 準則 ； 用藥安全 ； elderly ； potentially inappropriate medication ； criteria ； medication safety

長期照護雜誌

23卷2期（2019 / 10 / 01）

95 - 110

繁體中文

當老人之處方藥物治療風險大過於益處時即被視為潛在不適當用藥，不適當用藥與藥物安全問題有著很大的關係，自從世界各國評估老人用藥適當性工具及準則被發表後，陸續有許多相關研究文獻，本文以敘述性回顧方式檢視老人不適當用藥準則，探討國內外相關文獻及研究結果，也特別介紹臺灣老人潛在不適當用藥準則及最常被使用的美國老人潛在不適當用藥準則。老年族群潛在性不適當用藥型態及盛行率，隨著不同的準則、國家、區域或被評估老人的機構型態不同而有所差異，經文獻統整後發現，許多國家已依據本身老年族群的藥物流行病學及現有藥物等相關因素，發展出比較符合該國的潛在性不適當用藥準則來使用，以促使該國或區域的老年族群的用藥可以被最適切的評估，並及早預防不良反應的發生。希望此文能提供給醫療專業人員，於提供長期或中期照護之老人個別化藥療管理與照護時之實證參考，以促使醫療專業人員能使用最適當的工具或準則來評估老人用藥適當性，為老人用藥安全之提昇共盡一己之力。

Potentially inappropriate medication (PIM) in the elderly occurs when the risks of use overweight the benefit, and it is strongly associated with the concerns of drug safety. Since many countries have proposed their PIM criteria in response to drug safety in the elderly, more and more relevant clinical research was published. This narrative review examined PIM for the elderly and summarizes the relevant literature and research findings. In particular, we introduced the PIM-Taiwan and the most commonly used PIM criteria, which was verified and modified by the American Geriatric Association. The assessment and prevalence of PIM for the elderly could vary by different criteria, countries and care institutes. Many countries have tried to establish applicable assessment criteria based upon their own pharmacoepidemiologic findings and available medication lists to facilitate appropriateness assessment and prevent adverse drug reactions from happening. This review was performed to provide evidence to enhance better quality of care in medication management and decision making toward the elderly who are taken care in the long-term or intermediate care units in the future. Hopefully, the health professionals could use the most appropriate assessment tool or criteria to provide efficient and collaborative care and improve elderly patients' medication safety.

1. American Geriatrics Society 2015 Beers Criteria Update Expert Panel(2015).American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.Journal of the American Geriatrics Society,63(11),2227-2246.
2. American Geriatrics Society Beers Criteria Update Expert Panel(2019).American Geriatrics Society 2019 Updated AGS Beers Criteria(R) for Potentially Inappropriate Medication Use in Older Adults.Journal of the American Geriatrics Society,67(4),674-694.
3. Arafat, S. M.,Mahmood, T.(2017).Chapter 81. Prescribing cascades in elderly. The Association of Physician of India.Progress in Medicine,2017,444-446.
4. Bahat, G.,Bay, I.,Tufan, A.,Tufan, F.,Kilic, C.,Karan, M. A.(2017).Prevalence of potentially inappropriate prescribing among older adults: A comparison of the Beers 2012 and Screening Tool of Older Person's Prescriptions criteria version 2.Geriatrics & Gerontology International,17(9),1245-1251.
5. Barry, P. J.,Gallagher, P.,Ryan, C.,O'Mahony, D.(2007).START (screening tool to alert doctors to the right treatment)-- an evidence-based screening tool to detect prescribing omissions in elderly patients.Age and Ageing,36(6),632-638.
6. Blanco-Reina, E.,Ariza-Zafra, G.,Ocana-Riola, R.,Leon-Ortiz, M.(2014).2012 American Geriatrics Society Beers criteria: Enhanced applicability for detecting potentially inappropriate medications in European older adults? A comparison with the Screening Tool of Older Person's Potentially Inappropriate Prescriptions.Journal of the American Geriatrics Society,62(7),1217-1223.
7. Boland, B.,Guignard, B.,Dalleur, O.,Lang, P. O.(2016).Application of STOPP/START and Beers criteria: Compared analysis on identification and relevance of potentially inappropriate prescriptions.European Geriatric Medicine,7(5),416-423.
8. Chang, C. B.,Chan, D. C.(2010).Comparison of published explicit criteria for potentially inappropriate medications in older adults.Drugs & Aging,27(12),947-957.
9. Chang, C. B.,Yang, S. Y.,Lai, H. Y.,Wu, R. S.,Liu, H. C.,Hsu, H. Y.,Chan, D. C.(2015).Application of three different sets of explicit criteria for assessing inappropriate prescribing in older patients: A nationwide prevalence study of ambulatory care visits in Taiwan.BMJ Open,5(11),e008214.
10. Chang, C. B.,Yang, S. Y.,Lai, H. Y.,Wu, R. S.,Liu, H. C.,Hsu, H. Y.,Chan, D. C.(2012).Using published criteria to develop a list of potentially inappropriate medications for elderly patients in Taiwan.Pharmacoepidemiology and Drug Safety,21(12),1269-1279.
11. Corsonello, A.,Pedone, C.,Lattanzio, F.,Lucchetti, M.,Garasto, S.,Di Muzio, M.,Antonelli Incalzi, R.(2009).Potentially inappropriate medications and functional decline in elderly hospitalized patients.Journal of the American Geriatrics Society,57(6),1007-1014.
12. Corsonello, A.,Pranno, L.,Garasto, S.,Fabietti, P.,Bustacchini, S.,Lattanzio, F.(2009).Potentially inappropriate medication in elderly hospitalized patients.Drugs & Aging,26(Suppl 1),31-39.
13. Di Giorgio, C.,Provenzani, A.,Polidori, P.(2016).Potentially inappropriate drug prescribing in elderly hospitalized patients: An analysis and comparison of explicit criteria.Internationl Journal of Clinical Pharmacy,38(2),462-468.
14. Fadare, J. O.,Desalu, O. O.,Obimakinde, A. M.,Adeoti, A. O.,Agboola, S. M.,Aina, F. O.(2015).Prevalence of inappropriate medication prescription in the elderly in Nigeria: A comparison of Beers and STOPP criteria.The International Journal of Risk & Safety in Medicine,27(4),177-189.
15. Gallagher, P.,O'Mahony, D.(2008).STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): Application to acutely ill elderly patients and comparison with Beers' criteria.Age and Ageing,37(6),673-679.
16. Hanlon, J. T.,Schmader, K. E.(2013).The medication appropriateness index at 20: Where it started, where it has been, and where it may be going.Drugs & Aging,30(11),893-900.
17. Hilmer, S. N.,Mager, D. E.,Simonsick, E. M.,Cao, Y.,Ling, S. M.,Windham, B. G.,Abernethy, D. R.(2007).A drug burden index to define the functional burden of medications in older people.Archives of Internal Medicine,167(8),781-787.
18. Holt, S.,Schmiedl, S.,Thurmann, P. A.(2010).Potentially inappropriate medications in the elderly: The PRISCUS list.Deutsches Arzteblatt International,107(31-32),543-551.
19. Karandikar, Y. S.,Chaudhari, S. R.,Dalal, N. P.,Sharma, M.,Pandit, V. A.(2013).Inappropriate prescribing in the elderly: A comparison of two validated screening tools.Journal of Clinical Gerontology and Geriatrics,4(4),109-114.
20. Kinirons, M. T.,O'Mahony, M. S.(2004).Drug metabolism and ageing.British Journal of Clinical Pharmacology,57(5),540-544.
21. Laroche, M. L.,Charmes, J. P.,Merle, L.(2007).Potentially inappropriate medications in the elderly: A French consensus panel list.European Journal of Clinical Pharmacology,63(8),725-731.
22. Lee, S. S.,Schwemm, A. K.,Reist, J.,Cantrell, M.,Andreski, M.,Doucette, W. R.,Farris, K. B.(2009).Pharmacists' and pharmacy students' ability to identify drug-related problems using TIMER (Tool to Improve Medications in the Elderly via Review).American Journal of Pharmaceutical Education,73(3),52.
23. McLeod, P. J.,Huang, A. R.,Tamblyn, R. M.,Gayton, D. C.(1997).Defining inappropriate practices in prescribing for elderly people: A national consensus panel.Canadian Medical Association Journal,156(3),385-391.
24. Neves, S. J.,Marques, A. P.,Leal, M. C.,Diniz Ada, S.,Medeiros, T. S.,Arruda, I. K.(2013).Epidemiology of medication use among the elderly in an urban area of Northeastern Brazil.Revista de Saude Publica,47(4),759-768.
25. Novaes, P. H.,da Cruz, D. T.,Lucchetti, A. L. G.,Leite, I. C. G.,Lucchetti, G.(2017).Comparison of four criteria for potentially inappropriate medications in Brazilian community-dwelling older adults.Geriatrics & Gerontology International,17(10),1628-1635.
26. Oliveira, M. G.,Amorim, W. W.,de Jesus, S. R.,Heine, J. M.,Coqueiro, H. L.,Passos, L. C.(2015).A comparison of the Beers and STOPP criteria for identifying the use of potentially inappropriate medications among elderly patients in primary care.Journal of Evaluation in Clinical Practice,21(2),320-325.
27. Rancourt, C.,Moisan, J.,Baillargeon, L.,Verreault, R.,Laurin, D.,Gregoire, J. P.(2004).Potentially inappropriate prescriptions for older patients in long-term care.BMC Geriatrics,4,9.
28. Rognstad, S.,Brekke, M.,Fetveit, A.,Spigset, O.,Wyller, T. B.,Straand, J.(2009).The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. A modified Delphi study.Scandinavian Journal Primary Health Care,27(3),153-159.
29. Ryan, C.,O'Mahony, D.,Kennedy, J.,Weedle, P.,Byrne, S.(2009).Potentially inappropriate prescribing in an Irish elderly population in primary care.British Journal of Clinical Pharmacology,68(6),936-947.
30. San-Jose, A.,Agusti, A.,Vidal, X.,Formiga, F.,Lopez-Soto, A.,Fernandez-Moyano, A.,Barbe, J.(2014).Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing.European Journal of Internal Medicine,25(8),710-716.
31. Sera, L. C.,McPherson, M. L.(2012).Pharmacokinetics and pharmacodynamic changes associated with aging and implications for drug therapy.Clinics in Geriatric Medicine,28(2),273-286.
32. Spinewine, A.,Schmader, K. E.,Barber, N.,Hughes, C.,Lapane, K. L.,Swine, C.,Hanlon, J. T.(2007).Appropriate prescribing in elderly people: How well can it be measured and optimised?.Lancet,370(9582),173-184.
33. Tseng, H. Y.,Yu, S. H.,Lee, C. Y.,Huang, W. H.,Huang, S. L.,Wu, C. S.,Hsiung, C. A.(2018).Sedative-hypnotic drug use among community-dwelling elderly in Taiwan.International Psychogeriatrics,30(7),957-965.
34. Turnheim, K.(2004).Drug therapy in the elderly.Experimental Gerontology,39(11-12),1731-1738.
35. Winit-Watjana, W.,Sakulrat, P.,Kespichayawattana, J.(2008).Criteria for high-risk medication use in Thai older patients.Archives of Gerontology and Geriatrics,47(1),35-51.
36. Yu, N. W.,Chen, P. J.,Tsai, H. J.,Huang, C. W.,Chiu, Y. W.,Tsay, W. I.,Chang, C. M.(2017).Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: A nationwide nested case-control study in Taiwan.BMC Geriatrics,17(1),140.
37. 楊淑瑜,詹鼎正,張勤斌,賴秀昀,吳如琇,許秀櫻,張婉珍(2011)。臺灣老人潛在性不適當用藥評估工具的發展。長期照護雜誌，15(3)，223-236。
38. 衛生福利部中央健康保險署（2015a）。103 年65 歲以上就醫人口使用前 10 名健保藥品費用排行。取自 https://www.nhi.gov.tw/Resource/news/658_附表.pdf
39. 衛生福利部中央健康保險署（2019）。醫院以病人為中心門診整合照護計畫。取自http://www.nhi.gov.tw/resource/Query/ 醫院以病人為中心門診整合照護計畫.pdf
40. 衛生福利部中央健康保險署（2015b）。103 年西醫各年齡別藥費占率統計表。取自https://www.nhi.gov.tw/Resource/news/654_附表.pdf

1. 吳美慧(2022)。老人潛在不適當用藥之處方優化：以氫離子幫浦阻斷劑為例。長期照護雜誌，25(2)，185-201。