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.