Mối liên hệ giữa đa dược phẩm và đa dược phẩm quá mức với trạng thái suy yếu: một nghiên cứu tổng quan hệ thống và phân tích tổng hợp

European Geriatric Medicine - Tập 10 - Trang 9-36 - 2018
Katie Palmer1, Emanuele R. Villani2, Davide L. Vetrano2,3, Antonio Cherubini4, Alfonso J. Cruz-Jentoft5, Denis Curtin6, Michael Denkinger7, Marta Gutiérrez-Valencia8, Adalsteinn Guðmundsson9,10, Wilma Knol11, Diane V. Mak11, Denis O’Mahony6, Farhad Pazan12, Mirko Petrovic13, Chakravarthi Rajkumar14, Eva Topinkova15, Catarina Trevisan16, Tischa J. M. van der Cammen17,18,19, Rob J. van Marum20,21, Martin Wehling22, Gijsbertus Ziere18, Roberto Bernabei2, Graziano Onder2
1Fondazione Ospedale San Camillo IRCCS, Venezia, Italia
2Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
3Aging Research Center, NVS, Karolinska Institutet, Stockholm, Sweden
4Geriatria, Accettazione geriatrica e Centro di Ricerca Per l'invecchiamento, IRCCS INRCA, Ancona, Italy
5Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
6Department of Medicine, Department of Geriatric Medicine, University College Cork, Cork University Hospital, Cork, Ireland
7Agaplesion Bethesda Clinic Ulm, Geriatric Center Ulm/Alb-Donau and Geriatric Research Unit, Ulm University, Ulm, Germany
8Department of Pharmacy, Navarrabiomed, Universidad Pública de Navarra (UPNA), Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Spain
9Faculty of Medicine, University of Iceland, Reykjavík, Iceland
10Department of Geriatrics, Landspitali University Hospital, Reykjavík, Iceland
11Department of Geriatric Medicine, Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
12Institute for Clinical Pharmacology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
13Department of Internal Medicine, Section of Geriatrics, Ghent University, Ghent, Belgium
14Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
15Department of Geriatrics, First Faculty of Medicine, Charles University, General Faculty Hospital, Prague, Czech Republic
16Department of Medicine, Geriatrics Division, University of Padova, Padua, Italy
17Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
18Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
19Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, UK
20Department of General Practice and Old Age Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
21Department of Geriatrics, Jeroen Bosch Hospital, ‘S-Hertogenbosch, The Netherlands
22Medical Faculty Mannheim, Clinical Pharmacology, University of Heidelberg, Heidelberg, Germany

Tóm tắt

Nghiên cứu nhằm: (1) mối liên hệ cắt ngang giữa đa dược phẩm, đa dược phẩm quá mức và sự hiện diện của tình trạng suy yếu hoặc gần suy yếu; (2) nguy cơ xảy ra tình trạng gần suy yếu hoặc suy yếu ở những người dùng đa dược phẩm, và ngược lại. Một nghiên cứu tổng quan hệ thống và phân tích tổng hợp đã được thực hiện theo hướng dẫn PRISMA. Chúng tôi đã tìm kiếm trên PubMed, Web of Science và Embase từ ngày 01/01/1998 đến ngày 5/2/2018. Các ước tính gộp được thu được thông qua các mô hình hiệu ứng ngẫu nhiên và trọng số Mantel-Haenszel. Độ đồng nhất được đánh giá bằng thống kê I2 và thiên kiến xuất bản được kiểm tra bằng các bài kiểm tra của Egger và Begg. Ba mươi bảy nghiên cứu đã được đưa vào phân tích. Tỷ lệ gộp của đa dược phẩm ở những người có tình trạng gần suy yếu và suy yếu lần lượt là 47% (95% CI 33–61) và 59% (95% CI 42–76). Tỷ lệ odds gia tăng của đa dược phẩm đã được quan sát thấy ở những người gần suy yếu (tỷ lệ odds gộp OR = 1.52; 95% CI 1.32–1.79) và suy yếu (tỷ lệ odds gộp OR = 2.62, 95% CI 1.81–3.79). Đa dược phẩm quá mức cũng gia tăng ở những người gần suy yếu (OR = 1.95; 95% CI 1.41–2.70) và suy yếu (OR = 6.57; 95% CI 9.57–10.48) so với những người có sức khỏe tốt. Chỉ có bảy nghiên cứu ngang đã báo cáo dữ liệu về nguy cơ xảy ra tình trạng gần suy yếu hoặc suy yếu ở những người có đa dược phẩm ban đầu. Một tỷ lệ odds cao hơn có ý nghĩa trong việc phát triển tình trạng gần suy yếu đã được phát hiện ở những người khỏe mạnh với đa dược phẩm (tỷ lệ odds gộp OR = 1.30; 95% CI 1.12–1.51). Chúng tôi chưa tìm thấy tài liệu nào điều tra về tần suất đa dược phẩm ở những người có tình trạng gần suy yếu/suy yếu. Đa dược phẩm là phổ biến ở những người gần suy yếu và suy yếu, và những cá nhân này cũng có khả năng cao hơn để sử dụng các chế độ thuốc cực đoan, tức là đa dược phẩm quá mức, so với những người cao tuổi khỏe mạnh. Cần nhiều nghiên cứu hơn để điều tra mối quan hệ nguyên nhân giữa đa dược phẩm và các hội chứng suy yếu, từ đó xác định các cách để đồng thời giảm gánh nặng thuốc và tình trạng gần suy yếu/suy yếu ở những cá nhân này. CRD42018104756.

Từ khóa

#đa dược phẩm #đa dược phẩm quá mức #tình trạng suy yếu #nghiên cứu tổng quan #phân tích tổng hợp

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European Geriatric Medicine

Tập 10

9-36

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