老年人多重用药依从性现状及影响因素的Meta分析
urrent Status of Polypharmacy in the Elderly and Its Influencing Factors：a Meta-analysis
背景??老年人多重用药现象已日益普遍。而多重用药依从性与其治疗效果及安全性密切相关，故早期了解老年人多重用药依从性及其影响因素具有重要意义。但目前研究结论差异较大，尚无明确统一的标准。目的??系统评价老年人多重用药依从性现状及其影响因素，为后期提高老年人多重用药依从性，减少不良反应，进一步制订个性化干预方案提供参考。方法??计算机检索PubMed、Embase、Web?of?Science、Cochrane?Library、Scopus、Ovid、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网中有关老年人多重用药（年龄≥60岁，用药种类≥5种）依从性影响因素的队列研究、病例对照研究、横断面研究等观察性研究，检索时限为建库至2023年7月。由2名研究者按照纳入与排除标准独立进行文献筛选、质量评价以及资料提取。采用Stata17.0和RevMan5.3软件进行Meta分析。结果??共纳入19篇文献，总样本量为130047例，其中服药依从性好的人数为50852例。Meta分析结果显示，老年人多重用药的服药依从率为41%〔95%CI（0.34，0.47）〕，多重用药依从性与年龄〔OR=2.62，95%CI（1.60，4.78），P<0.0001〕、性别〔OR=1.70，95%CI（1.30，2.23），P=0.0001〕、文化程度〔OR=1.73，95%CI（1.38，2.16），P<0.00001〕、居住方式〔OR=2.85，95%CI（2.18，3.72），P<0.00001〕、用药知识水平〔OR=1.14，95%CI（1.04，1.25），P=0.005〕、服药信念〔OR=2.06，95%CI（1.44，2.93），P<0.0001〕、抑郁〔OR=2.52，95%CI（1.96，3.24），P<0.00001〕、日常生活能力（ADL）〔OR=2.39，95%CI（1.68，3.38），P<0.00001〕、跌倒史〔OR=3.51，95%CI（2.03，6.06），P<0.00001〕、专业人员指导〔OR=3.75，95%CI（1.92，7.33），P=0.0001〕、用药种类数量〔OR=2.58，95%CI（1.96，3.41），P<0.0001〕、药物不良反应〔OR=3.08，95%CI（2.17，4.38），P<0.0001〕、用药方案复杂性〔OR=1.08，95%CI（1.03，1.14），P=0.004〕、药物管理〔OR=1.92，95%CI（1.34，2.75），P=0.0003〕、用药费用〔OR=2.60，95%CI（1.30，5.17），P=0.0007〕有关。敏感性分析结果显示，Meta分析结果相对稳定。Begg's检验（P=0.441）和Egger's检测（P=0.674）提示纳入文献的发表偏倚风险较低。结论??老年人多重用药依从率为41%。且现有证据表明：一般因素（年龄、性别、文化程度、居住方式），心理、社会因素（抑郁、ADL、跌倒史、用药知识水平、服药信念、专业人员指导），药物因素（药物管理、用药费用、用药方案复杂性、用药种类数量、药物不良反应）是老年人多重用药依从性的影响因素，医务人员应根据老年人多重用药依从性的影响因素，制订个性化的干预措施，优化多重用药老年人疾病管理。
Background??Polypharmacy is increasingly common in the elderly. The medication compliance of polypharmacy is closely related to its therapeutic effect and safety. Thereforeit is of great significance to understand the medication compliance and its influencing factors in the elderly with polypharmacy at early stage. Howeverthe conclusions of current studies vary greatlyand there is no clear and unified standard. Objective??To systematically evaluate the current status of polypharmacy in the elderly and its influencing factorsin order to provide reference for improving medication compliance of polypharmacy in the elderlyreducing adverse reactionsand further developing individualized intervention programs. Methods??PubMedEMBaseWeb of ScienceCochrane LibraryScopusOvidCBMCNKIWanfang Data and VIP were searched for cohort studiescase-control studiescross-sectional studies and other observational studies on the influencing factors of medication compliance of polypharmacy in the elderly from inception to July 2023. Two researchers independently screened the literatureevaluated the quality and extracted the data according to the inclusion and exclusion criteria. Stata 17.0 and RevMan 5.3 software were used for meta-analysis. Results ?A total of 19 studies were included with the total sample size of 130 047 subjectsincluding 50 852 subjects with good medication compliance. Meta-analysis results showed that the medication compliance rate of polypharmacy in the elderly was 41%95%CI0.340.47which was associated with ageOR=2.6295%CI1.604.78P<0.000 1genderOR=1.7095%CI1.302.23P=0.000 1education levelOR=1.7395%CI1.382.16P<0.0000 1residential lifestyleOR=2.8595%CI2.183.72P<0.000 01medication knowledge levelOR=1.1495%CI1.041.25P=0.005medication beliefOR=2.0695%CI1.442.93P<0.000 1depressionOR=2.5295%CI1.963.24P<0.000 01daily living abilityADLOR=2.3995%CI1.683.38P<0.000 01history of fallsOR=3.5195%CI2.036.06P<0.000 01professional guidance OR=3.7595%CI1.927.33P=0.000 1the number of drug typesOR=2.5895%CI1.963.41P<0.000 1adverse drug reactionsOR=3.0895%CI2.174.38P<0.000 1medication regimen complexity OR=1.0895%CI1.031.14P=0.004medication managementOR=1.9295%CI1.342.75P=0.0003 and medication costOR=2.6095%CI1.305.17P=0.000 7. Sensitivity analysis showed that the results of metaanalysis were relatively stable. Begg's testP=0.441 and Egger's test P=0.674 suggested that there was a low risk of publication bias for medication compliance of polypharmacy in the elderly in the included studies. Conclusion ?The compliance rate of polypharmacy in the elderly is 41%. And the available evidence shows that general factorsagegendereducation levelresidential lifestylepsychological and social factorsdepressionADLhistory of fallsmedication knowledge levelmedication beliefprofessional guidancedrug factorsmedication managementmedication costmedication regimen complexitythe number of drug typesadverse drug reactions are the influencing factors of medication compliance of polypharmacy in the elderly. Medical staff should formulate individualized intervention measures and optimize disease management in the elderly with polypharmacy according to the influencing factors of medication compliance of polypharmacy.
高静、卢贤英、李月、柏丁兮、何佳丽、谢雪梅
10.12114/j.issn.1007-9572.2023.0274
医药卫生理论医学研究方法预防医学
多重用药老年人服药依从性影响因素Meta 分析
PolypharmacygedMedication adherenceRoot cause analysisMeta-analysis
高静,卢贤英,李月,柏丁兮,何佳丽,谢雪梅.老年人多重用药依从性现状及影响因素的Meta分析[EB/OL].(2023-07-27)[2025-08-02].https://chinaxiv.org/abs/202307.00674.点此复制
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