减少中枢神经系统活性药物以预防老年人中跌倒和受伤:一个集群随机临床试验
Elizabeth A Phelan1,2, Brian D Williamson3,4,5, Benjamin H Balderson3
1Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle.
使用中枢神经系统活性药物的老年人抑郁症干预措施并没有减少医疗治疗的跌倒. 虽然它改善了一些药物的药物停用,但它并没有显著影响主要结果.
科学领域:
- 老年学是指老年学的学科.
- 临床药理学 临床药理学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 高风险药物经常被处方给老年人,增加不良健康结果.
- 处方干预措施旨在减少这些药物的使用,但往往没有关注患者相关的健康结果.
研究的目的:
- 对老年人和他们的初级保健临床医生进行健康系统内嵌的抑郁症治疗干预措施进行评估.
- 该干预措施的目标是减少中枢神经系统活性药物的使用,并预防医疗治疗的跌倒.
主要方法:
- 一个集群随机临床试验,涉及18个初级保健实践和2367名老年成人患者.
- 干预包括患者教育和临床医生决策支持;对照组接受了通常的护理.
- 主要结局是医疗治疗的跌倒,次要结局包括药物停用和剂量减少.
主要成果:
- 与通常的护理相比,干预措施没有显著减少医疗治疗的跌倒 (调整后的危险比,1.11;P=.11).
- 在干预组中,在三环抗抑郁药的停用,持续停用和剂量减少方面观察到显著的改善.
- 在主要结果中没有发现显著差异,但在处方方面发现了适度的益处.
结论:
- 医疗系统内嵌的抑郁症干预措施在减少老年人接受医疗治疗的跌倒方面并不比常规护理更有效.
- 虽然干预措施在减少特定药物类别方面显示出好处,但它没有达到主要的临床结果.
- 可能需要进一步的研究来确定可以在老年人群中产生可衡量的临床益处的抑郁症策略.
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