認知症患者への薬物治療が生命予後に及ぼす影響についての検討  [in Japanese] Effects of drug treatment on the surviral-time in patients with dementia  [in Japanese]

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Author(s)

    • 間辺 利江 Manabe Toshie
    • 帝京大学医学部|筑波大学大学院人間総合科学研究科|名古屋市立大学大学院医学研究科 Department of Hygiene and Public Health, Teikyo University School of Medicine|Department of Social Health and Stress Management, University of Tsukuba, Graduate School of Comprehensive Human Science|Department of Community-based Medicine, Nagoya City University Graduate School of Medicine
    • 赤津 裕康 Akatsu Hiroyasu
    • 名古屋市立大学大学院医学研究科|医療法人さわらび会福祉村病院 Department of Community-based Medicine, Nagoya City University Graduate School of Medicine|Fukushimura Hospital
    • 水上 勝義 Mizukami Katsuyoshi
    • 筑波大学大学院人間総合科学研究科|筑波大学体育系 Department of Social Health and Stress Management, University of Tsukuba, Graduate School of Comprehensive Human Science|Faculty of Health and Sport Sciences, University of Tsukuba
    • 松岡 珠実 Matsuoka Tamami
    • 筑波大学大学院人間総合科学研究科 Department of Social Health and Stress Management, University of Tsukuba, Graduate School of Comprehensive Human Science
    • 大原 弘隆 Ohara Hirotaka
    • 名古屋市立大学大学院医学研究科 Department of Community-based Medicine, Nagoya City University Graduate School of Medicine

Abstract

<p><b>目的:</b>高齢者の薬物治療は多剤併用による有害事象の出現など課題が多い.しかし認知症高齢者の薬物治療の影響についての詳細な報告は未だ乏しい.<b>方法:</b>愛知県豊橋市の病院に,2012年1月~2016年12月に入院,死亡退院し,剖検により臨床神経病理学的に認知症と確定診断された患者を対象に後ろ向き観察研究を行った.基本属性,入院時臨床症状,入院前一年間のBPSD・老年症候群等を収集,対象患者を入院時持参の薬剤数で二群間に分け(≥5剤/多剤併用vs. ≤4剤/非多剤併用)比較した.多剤併用及び慎重に投与すべき薬剤の生命予後期間への影響をKaplan-Meier法及びCox回帰分析にて推定した.薬効分類は薬価基準収載医薬品コードに,慎重に投与すべき薬剤は「高齢者の安全な薬物療法ガイドライン2015(日本老年医学会編集)」に従った.<b>結果:</b>対象者76名の平均持参薬剤数は4剤であった.内,39.5%が多剤併用であった.観察項目の二群間比較では老年症候群の歩行障害が多剤併用群(93.3%)に有意に多かった.慎重投与薬剤の処方は多剤併用群に有意に多かった(p<0.001).Kaplan-Meier法による生存期間の二群間比較では≥5剤群が≤4剤群より短い傾向が示された(p=0.067).生命予後期間への影響は,多剤併用で短縮リスクが高い傾向にあり,これは性別及び入院時年齢での調整でより顕著であった(調整ハザード比,1.631;95%CI,0.991~2.683;p=0.054).慎重投与薬剤の有無及び,睡眠鎮静剤,抗不安剤,精神神経用剤,その他の中枢神経用薬,ベンゾジアゼピン系薬剤は,生命予後への影響は観察されなかった.<b>結論:</b>本研究により人生の終末期にある認知症高齢者への多剤併用は,生命予後短縮のリスクとなる傾向が示唆された.</p>

<p><b>Aim: </b>The effect of polypharmacy on the surviral-time in patients with dementia has never been fully elucidated.</p><p><b>Methods: </b>A retrospective study was conducted in a hospital in Aichi, Japan, by reviewing the medical charts and autopsy reports. Patients were hospitalized and neuropathologically diagnosed with dementia. The data on medication was collected from the prescribed drugs taking right before the admission. Patients were divided into two groups according to the number of prescribed drugs: ≥ 5 drugs (polypharmacy) vs. ≤ 4 drugs (non-polypharmacy). "Drugs to be prescribed with special caution" were defined in accordance with the guidelines for medical treatment and its safety in the elderly (2015).</p><p><b>Results: </b>Seventy-six patients were eligible, and 39.5% of patients had polypharmacy. The Kaplan-Meier method showed that the polypharmacy group tended to have a shorter survival-time than the non-polypharmacy group (<i>p</i>=0.067). A Cox proportional hazard model showed that the polypharmacy group tended to have a higher risk for a reduced survival-time than the non-polypharmacy group, and this tendency was more prominent after adjusting for sex and age at admission (adjusted hazard ratio, 1.631; 95% confidence interval, 0.991-2.683; <i>p</i>=0.054). "Drugs to be prescribed with special caution", including hypnotic-sedative drugs, antianxiety drugs, antipsychotics, and benzodiazepines, were not found to be risk factors for a reduced survival-time.</p><p><b>Conclusions: </b>The present study showed that polypharmacy in terminal patients with dementia tended to carry a risk for reducing their remaining lifespan. The results warrant further additional study.</p>

Journal

  • Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics

    Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics 56(2), 171-180, 2019

    The Japan Geriatrics Society

Codes

  • NII Article ID (NAID)
    130007650185
  • NII NACSIS-CAT ID (NCID)
    AN00199010
  • Text Lang
    JPN
  • ISSN
    0300-9173
  • NDL Article ID
    029722814
  • NDL Call No.
    Z19-25
  • Data Source
    NDL  J-STAGE 
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