前言：老人潛在不適當用藥問題在國內外逐漸受到重視，因老化及慢性疾病狀態，潛在不適當處方增加發生藥物不良反應之機會。護理之家年長住民因共病症較複雜，許多研究都顯示潛在性不適當處方之盛行率較一般老年人高，而其相關危險因子仍未有明確定論。本研究意欲探究護理之家年長住民之潛在不適當處方之盛行率以及相關危險因子。
方法：本研究資料取自2015年7月至12月臺灣中部四間護理之家接受某區域醫院家醫科門診開立慢性處方之60歲以上207位年長住民，根據病歷紀錄患者之年齡、性別、慢性病狀態以及處方藥物，使用2015年Beers Criteria評估患者潛在性不適當處方。以Student’s t檢定和卡方檢定各變項與潛在性不適當處方之相關性，進而以多變項邏輯斯迴歸模式分析，探究潛在性不適當處方之危險因子。
結果：研究對象平均年齡為81.2 ± 9.5歲；平均慢性病數目為5.8 ± 1.6種；平均藥物數目為6.3 ± 2.2個；平均Charlson’s comorbidity index為3.7± 2.1分；平均巴氏量表分數為4.3± 11.2分。其中136位(65.7%)有一項以上潛在性不適當處方。207位患者常見之慢性病診斷為消化系統疾病(75.4%)、循環系統疾病(68.1%)以及神經系統疾病(60.4%)。136位患者服用之PIM，常見的包括抗精神病藥物(28.0%)、Metoclopramide(25.4%)、苯二氮平類藥物(21.7%)以及H2受體阻斷劑(13.0%)。經多變項邏輯斯回歸分析顯示，潛在性不適當處方與藥物數目(勝算比= 1.42；95%信賴區間= 1.19-1.69；p < 0.001)及精神科疾病(勝算比= 4.38；95%信賴區間= 2.26-8.50；p < 0.001)有關。
結論：本研究顯示潛在不適當處方在護理之家年長住民中並不少見，臨床醫師對於多種藥物處方及精神科疾病患者，應考慮其高風險性潛在不適當處方的可能性。

Objective: Problems related to inappropriate prescriptions for older patients is considered a major public health issue in recent studies. Potentially inappropriate medications(PIMs) in elderly could could lead to an increase in the likelihood of adverse drug events because of aging and multiple chronic comorbidities. The prevalence of PIM use was high in nursing home residents in previous studies, but the factors associated with potentially inappropriate medication still had some controversies. The aim of our study is to identify the prevalence and risk factors for PIM use in older nursing home residents.
Methods: This study included 207 consecutive patients, aged ≥ 60 years, living in 4 nursing homes in central Taiwan, who received long-term prescriptions in family medicine clinics at a regional hospital between July 1 and December 31, 2015. PIM was assessed according to the 2015 updated Beers Criteria. Data regarding demographic characteristics, coexisting diseases, and prescriptions were collected and analyzed. The clinical factors related to PIM were determined using logistic regression.
Results: The mean age of the 207 residents was 81.2 ± 9.5 years. The mean number of comorbid conditions was 5.8 ± 1.6; the mean number of drugs prescribed was 6.3 ± 2.2. PIM was identified in 136 residents (65.7%). Most common chronic disease was diseases of digestive system (75.4%), followed by disease of circulatory system (68.1%) and disease of nervous system (60.4%). Most common PIMs were antipsychotics (28.0%), followed by metoclopramide (25.4%), benzodiazepines (21.7%), and H2-antagonists (13.0%). Multivariate analysis revealed that PIM was significantly associated with the number of drugs prescribed (p< 0.001) and psychiatric illnesses (p< 0.001).
Conclusions: The prevalence of PIM in older nursing home residents was not rare. Clinicians should be alert to the possibility of PIM in older nursing home residents, especially in those taking multiple medications and those who have psychiatric illnesses.

謝誌---------------------------------------------------------------------------------I
中文摘要--------------------------------------------------------------------------II
英文摘要-------------------------------------------------------------------------IV
第一章 緒論
第一節 研究背景與動機-------------------------------------------------1
第二節 潛在不適當處方之評估工具----------------------------------2
第三節 Beers Criteria之發展與應用-----------------------------------3
第四節 研究目的----------------------------------------------------------4
第二章 文獻探討
第一節 潛在不適當處方之盛行率-------------------------------------5
第二節 潛在不適當處方之危險因子----------------------------------5
第三章 研究設計
第一節 研究對象與資料收集-------------------------------------------7
第二節 研究工具----------------------------------------------------------7
第三節 研究架構----------------------------------------------------------8
第四節 統計分析----------------------------------------------------------9
第四章 研究結果
第一節 病患基本特性---------------------------------------------------10
第二節 單變項分析------------------------------------------------------12
第三節 多變項邏輯斯迴歸分析--------------------------------------12
第五章 討論
第一節 潛在不適當處方之盛行率-----------------------------------13
第二節 常見潛在不適當處方之藥物--------------------------------13
第三節 潛在不適當處方之危險因子--------------------------------15
第四節 研究限制--------------------------------------------------------17
第五節 研究優勢--------------------------------------------------------18
第六章 結論與建議-----------------------------------------------------------19
參考文獻-------------------------------------------------------------------------20
表目錄

表一 護理之家年長住民PIM盛行率與相關因子比-------------------30
表二 慢性疾病種類及其相關疾病診斷碼--------------------------------33
表三 護理之家年長住民之臨床特性--------------------------------------34
表四 護理之家年長住民之潛在不適當處方，根據2015年Beers Criteria：老年病患應避免之潛在不適當處方藥物--------------36
表五 護理之家年長住民之潛在不適當處方，根據2015年Beers Criteria：特定疾病或症候群下，應避免之潛在性不適當處方藥物--------------------------------------------------------------------------37
表六 潛在不適當處方危險因子之單變項分析--------------------------38
表七 潛在不適當處方危險因子之多變項分析--------------------------40

圖目錄
圖一 研究流程圖--------------------------------------------------------------41
圖二 研究架構圖--------------------------------------------------------------42

附錄一 2015年Beers Criteria：老年患者應避免之潛在不適當用藥--------------------------------------------------------------------------43
附錄二 2015年Beers Criteria：特定疾病或症候群下應避免之老年潛在不適當用藥--------------------------------------------------------52
附錄三 2015年Beers Criteria：非抗感染性藥物，藥物交互作用下老年患者需避免之用藥-----------------------------------------------56
附錄四 2015年Beers Criteria：非抗感染性藥物，於腎功能不良之老年患者需避免或減低劑量之用藥--------------------------------58
附錄五 合併症嚴重度評估Charlson’s comorbidity index--------------60
附錄六 巴氏量表Barthel Index---------------------------------------------61

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