老人潛在不適當用藥之處方優化：以氫離子幫浦阻斷劑為例

Deprescribing Potentially Inappropriate Medication(s) among Older Adults: Proton Pump Inhibitor as an Example

多重用藥可能因為潛在不適當用藥與藥物不良事件增加老年人跌倒、身體與認知功能損傷、住院、甚至死亡。長期使用氫離子幫浦阻斷劑（proton pump inhibitor，簡稱PPI）會增加困難梭狀桿菌感染有關的腹瀉、肺炎與骨折的風險。處方優化可管理多重用藥並改善結果。本研究旨在評估對長期使用PPI老年人進行處方優化是安全、有效和可行的介入措施，以改善用藥安全和健康。本研究自電子資料庫（PubMed、EMBASE等）搜尋文獻，包含各資料庫從收錄年代至2019年2月21日。選取符合研究主題：使用PPI持續超過8週之老年人，排除需要PPI提供胃保護者，評估老年人PPI處方優化的影響。符合選取標準納入的研究3篇，結果發現：停止PPI易導致腸胃道症狀復發，達顯著差異。逐漸減少劑量停用PPI的成功率比較高，但未達顯著差異。而需要時使用PPI症狀緩解之比較，未達顯著差異；每日消耗藥丸數量較低，達顯著差異；藥物便利性或主觀滿意度皆未達顯著差異。由於納入的篇數較少，需要更多隨機對照試驗針對此議題進行調查。

Polypharmacy may increase incidents of falls, physical and cognitive impairment, hospitalization and even death due to potentially inappropriate medications and adverse drug events. Chronic use of proton pump inhibitors (PPI) increases the risk of diarrhea associated with Clostridium difficile infections, pneumonia, and fractures. Deprescribing may manage polypharmacy and improve outcomes. The aim of this study is to evaluate the safety, effectiveness and feasibility of the intervention conducted by deprescribing of long-term PPI for the improvement of medication safety and health outcomes among older adults. We searched online electronic databases (e.g., PubMed, EMBASE) from the earliest record to February 21, 2019. The inclusion criteria were the studies that evaluated older adults who took PPI for more than 8 weeks. The exclusion criteria were the necessarily chronic use of PPI to provide gastroprotection. The effects associated with deprescribing PPI in older adults were determined. There were 3 studies that met the inclusion criteria. The results showed the discontinuation method significantly increased the risk of recurrence of gastrointestinal symptoms. The successful discontinuation rate of the tapering method was higher, but without statistical significance. The on-demand method displayed nonsignificant difference for the comparison of symptom alleviation, but significantly lower number of pills consumed daily. No significant differences were found for convenience of medication and subjective satisfaction. Due to the small number of studies included, the result of this meta-analysis in regard to the deprescribing of long-term PPI among older adults is not conclusive. Further randomized controlled trials are required for the exploration of the relevant issues in the future.