Prevalence of inappropriate medication use in residential long-term care facilities for the elderly: A systematic review

Background: Multi-morbidity and polypharmacy of the elderly population enhances the probability of elderly in residential long-term care facilities experiencing inappropriate medication use. Objectives: The aim is to systematically review literature to assess the prevalence of inappropriate medication use in residential long-term care facilities for the elderly. Methods: Databases (MEDLINE, EMBASE) were searched for literature from 2004 to 2016 to identify studies examining inappropriate medication use in residential long-term care facilities for the elderly. Studies were eligible when relying on Beers criteria, STOPP, START, PRISCUS list, ACOVE, BEDNURS or MAI instruments. Inappropriate medication use was defined by the criteria of these seven instruments. Results: Twenty-one studies met inclusion criteria. Seventeen studies relied on a version of Beers criteria with prevalence ranging between 18.5% and 82.6% (median 46.5%) residents experiencing inappropriate medication use. A smaller range, from 21.3% to 63.0% (median 35.1%), was reported when considering solely the 10 studies that used Beers criteria updated in 2003. Prevalence varied from 23.7% to 79.8% (median 61.1%) in seven studies relying on STOPP. START and ACOVE were relied on in respectively four (prevalence: 30.5–74.0%) and two studies (prevalence: 28.9–58.0%); PRISCUS, BEDNURS and MAI were all used in one study each. Conclusions: Beers criteria of 2003 and STOPP were most frequently used to determine inappropriate medication use in residential long-term care facilities. Prevalence of inappropriate medication use strongly varied, despite similarities in research design and assessment with identical instrument(s).

背景：老年人群的共病与多重用药现象，提升了养老长期照护机构内老年入住者发生不适当用药的概率。
目标：本研究旨在通过系统综述相关文献，评估养老长期照护机构内老年入住者的不适当用药患病率。
方法：本研究检索了2004年至2016年间MEDLINE、EMBASE数据库的文献，以筛选考察养老长期照护机构老年入住者不适当用药情况的研究。纳入研究需采用比尔斯标准（Beers criteria）、老年人潜在不适当用药筛查工具（STOPP）、老年人用药适宜性评估工具（START）、PRISCUS列表（PRISCUS list）、ACOVE工具（ACOVE）、BEDNURS工具（BEDNURS）或MAI工具（MAI）作为评估依据，且不适当用药的定义需符合上述7种工具的判定标准。
结果：共计21项研究符合纳入标准。其中17项研究采用了比尔斯标准（Beers criteria）的不同版本，其报道的老年入住者不适当用药患病率范围为18.5%至82.6%（中位数46.5%）。仅纳入采用2003年更新版比尔斯标准的10项研究时，患病率范围缩小至21.3%至63.0%（中位数35.1%）。采用STOPP的7项研究中，患病率为23.7%至79.8%（中位数61.1%）；分别有4项和2项研究采用START与ACOVE工具，其患病率分别为30.5%~74.0%与28.9%~58.0%；PRISCUS列表、BEDNURS与MAI工具则各有1项研究采用。
结论：2003年版比尔斯标准与STOPP是目前养老长期照护机构中评估老年人不适当用药最常用的工具。尽管各项研究的研究设计与评估工具（或单一评估工具）具有相似性，但老年入住者不适当用药的患病率仍存在显著差异。