3.1 Analysis of PIM in old adult inpatients in our hospital
Among the 372 inpatients, 62.63%(233)inpatients used the drugs inChina PIM List for old adults . The incidence rate of PIM was slightly higher than the retrospective analysis result (61.15%) of PIM conducted by Liu Yulong et al. [6] on 317old adults inpatients. In the statistics of the PIM situation of old adult inpatients in our hospital, the barbiturate compound amidobarbital injection was included. This medicine is a compound preparation, and its components are aminopyrine, antipyrine and barbital. ; Ophthalmic drugs in aminoglycoside antibiotics are not included such as tobramycin dexamethasone ointment and the eye drops.
The incidence rate of PIM among female inpatients in our hospital is higher than that of female inpatients, which may be related to the sample size. The incidence rate of PIM in old adult inpatients ≥80 years old is higher than that of old adult inpatients aged from 65 to 79, the incidence rate of PIM in patients with inpatient days ≥10 is higher than that inpatients with inpatient days of 2-9, and the incidence rate of PIM in inpatients with diseases ≥4 is higher than that of inpatients with 1~3 diseases, it may be because that old adult inpatients have more complications, more severe illness condition, and different degrees of cognitive impairment [7], and it may also be related to the adverse drug reactions and drug interactions caused by taking a variety of drugs by old adult inpatients[8-10].
62.63%(233) patients in our hospital used the drugs in the China PIM List for old adults . The top three drugs with high incidence rate are spironolactone (15.21%), clopidogrel (11.22%) and insulin (11.22%). Spironolactone increases the risk of hyperkalemia in patients with heart failure . For old adult patients, blood potassium and electrocardiogram should be closely monitored, and using spironolactone with potassium-containing drugs such as penicillin, non-steroidal anti-inflammatory drugs, angiotensin converting anzyme inhibitior and angiotensin receptor inhibitor should better be avoided in treating old adult patients.When using clopidogrel, attention should be paid to bleeding and hematological abnormalities; If a patient is treated with aspirin, non-steroidal anti-inflammatory drugs, heparin or thrombolytic drugs, clopidogrel should be used with caution, and the patient should be monitored closely. There are many types of insulin in our hospital, including short-acting insulin, intermediate-acting insulin, long-acting insulin and premixed insulin. The appropriate insulin should be selected according to the blood glucose monitoring of the old adults, and the blood glucose of the patient should be closely monitored.
3.2 Personal advice on the China PIM List for old adults
The problem of rational use of drugs for old adult has become increasingly prominent. Now most clinical research and drug treatment guidelines focus on specific diseases, rather than the age or physical condition of special populations. Therefore, it is necessary to develop a list of PIMs for old adult. which provides a certain guarantee for the rational use of drugs.I have some doubts and questions on calculating the PIMs of old adult inpatients in our hospital based on theChina PIM List for old adults . ①In the disease state of peptic ulcer, the use of non-steroidal anti-inflammatory drugs will exacerbate the primary ulcer and cause new ulcers. It is recommended to add the disease state of gastrointestinal bleeding; in the disease state of gout, the use of thiazide diuretics will exacerbate or cause gout, it is recommended to add the disease state of hyperuricemia. ②It is recommended to add tramadol sustained-release tablets in the anesthetics and anesthetic adjuvants. There are more patients using tramadol sustained-release tablets in our hospital, while fewer patients use tramadol tablets and tramadol injection. ③In the China PIM List for old adults Chinese patent medicines can be added according to the national conditions. For example, Xiaoke Pills containing glibenclamide can also cause hypoglycemia in old adult patients; ④In the basic state of diabetes, long-term use of glucocorticoids will aggravate diabetes. The specific length of long-term use is recommended to be standardized; ⑤ In the case of a history of falls or fractures, the list of PIMs is dexzopiclone and zopiclone can be added. Ezopiclone is the dextrorotatory form of zopiclone, and the risk points of the two drugs are relatively similar.
There are no medical institutions in Huainan that have conducted investigations on PIMs in old adult, and only a few domestic medical institutions have conducted investigations and analysis based on theJudgement criteria of PIM in old adults in China . Thoroughly investigate the situation of PIMs in the old adults in our hospital, and providing suggestions for the next measures the hospital should take to improve the rational use of drugs for old adult patients in our hospital. At the same time, the applicability and practicability of 72 drugs included in the China PIM List for old adults were tested for the actual use of drugs in our hospital.