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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 張尚仁 | 調查尋求治療尿失禁治療的老年人其使用的藥物中哪一種較容易加重其症狀 | 2014/10/29 下午 06:45:40 | 0 |
| 原 文 | 題 目 | prevalence of commonly prescribed medications potentially contributing to urinary symptoms in a cohort of older patients seeking care for incontinence |
| 作 者 | Kashyap M, Tu le M, Tannenbaum C. | |
| 出 處 | BMC Geriatrics | |
| 出版日期 | 2013 june | |
| 評 論 | 由於就醫相當方便，台灣的老病人往往服用相當多的藥物，泌尿科門診有相當多因為尿失禁求診的老病人，泌尿科醫師除了專注於評估他們的下尿路與神經系統的功能之外，往往忘了這些病也服用了很多藥物來治療他們的慢性疾病，而這些藥物也加重了他們的尿失禁。這篇研究提醒了我們醫療這方面的缺失，根據此作者的研究，他們收集了因為尿失禁到泌尿科門診求診的超過六十歲的病人(九成為女性)，有六成的病人正在服用可能造成尿失禁的藥物，包含了Calcium channel blockers, benzodiazepines, centrally active agents, ACE inhibitors和estrogens，他們發現唯有多重藥物(服用五種藥物以上)是顯著造成這些病人服用這些會可能造成尿失禁藥物危險因子。由於這些病人本來就服用過多的藥物，我們在使用治療尿失禁的藥物來治療原本藥物的副作用，反而在過度增加這些原本就已經服用過多藥物的病人的藥物種類 形成“prescribing cascade”我們應該做的事找出那些容易造成尿失禁副作用的藥，減少藥物的種類，減少藥物副作用。 | |
| abstract |
Background Several medication classes may contribute to urinary symptoms in older adults. The purpose of this study was to determine the prevalence of use of these medications in a clinical cohort of incontinent patients. Methods A cross-sectional study was conducted among 390 new patients aged 60 years and older seeking care for incontinence in specialized outpatient geriatric incontinence clinics in Quebec, Canada. The use of oral estrogens, alpha-blocking agents, benzodiazepines, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, NSAIDs, narcotics and calcium channel blockers was recorded from each patient’s medication profile. Lower urinary tract symptoms and the severity of incontinence were measured using standardized questionnaires including the International Consultation on Incontinence Questionnaire. The type of incontinence was determined clinically by a physician specialized in incontinence. Co-morbidities were ascertained by self-report. Logistic regression analyses were used to detect factors associated with medication use, as well as relationships between specific medication classes and the type and severity of urinary symptoms. Results The prevalence of medications potentially contributing to lower urinary tract symptoms was 60.5%. Calcium channel blockers (21.8%), benzodiazepines (17.4%), other centrally active agents (16.4%), ACE inhibitors (14.4%) and estrogens (12.8%) were most frequently consumed. Only polypharmacy (OR = 4.9, 95% CI = 3.1-7.9), was associated with medication use contributing to incontinence in analyses adjusted for age, sex, and multimorbidity. No associations were detected between specific medication classes and the type or severity of urinary symptoms in this cohort. Conclusion The prevalence of use of medications potentially causing urinary symptoms is high among incontinent older adults. More research is needed to determine whether de-prescribing these medications results in improved urinary symptoms. |
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