老年患者潜在不适当用药的评估和干预进展

Assessment and intervention advances for potentially inappropriate medications in older adults

  • 摘要: 潜在不适当用药(potentially inappropriate medications,PIM)是指预期风险超过临床获益的药物,是老年患者发生跌倒、衰弱、再住院和死亡的重要风险因素,也是多重用药管理领域的研究热点。本文基于国内外研究进展,系统梳理了PIM 的评估工具与干预策略。对美国老年医学会Beers 标准、老年人不适当处方筛查工具(screening tool of older persons' prescriptions,STOPP)/老年人处方遗漏筛查工具(screening tool to alert to right treatment,START)标准以及中国PIM标准进行了比较分析。对处方精简干预、多学科团队协作干预以及人工智能支持下的创新干预策略进行了阐述,对各类策略在实践中的效果与面临的挑战进行了探讨,旨在为提升老年患者合理用药水平提供参考依据。

     

    Abstract: Potentially inappropriate medications (PIM) refer to drugs whose expected risks outweigh their clinical benefits. They represent a significant risk factor for falls, frailty, rehospitalization, and mortality in older adults and have thus become a research focus in the field of polypharmacy management. Based on recent domestic and international research advances, this article systematically reviews the assessment tools and intervention strategies for PIM. In terms of assessment, a comparative analysis is conducted on three major tools: the internationally recognized American Geriatrics Society Beers Criteria, the screening tool of older persons' prescriptions (STOPP) / screening tool to alert to right treatment (START) criteria, and the Chinese PIM criteria. Regarding interventions, the strategies of deprescribing, the multidisciplinary team collaboration model, and innovative artificial intelligence– supported interventions are elaborated. The article further discusses the effectiveness and challenges of these strategies in clinical practice, aiming to provide a reference for improving rational medication use in older patients.

     

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