medicina53巻10号

2016年09月発行

特集 超高齢時代の内科診療 総論

薬物治療で特に留意すべきポイント

著者： 北和也¹

所属機関： ¹やわらぎクリニック

ページ範囲：P.1528 - P.1534

ポイント
●超高齢者はmultimorbidity/comorbidity傾向にあり，ポリファーマシーに陥りやすい！
●implicit criteria（暗示的な基準）とexplicit criteria（明示的な基準）を処方整理に活かそう！
●超高齢者への処方では，余命を考慮した処方を考える必要がある─治療的か予防的か，それが問題だ．
●超高齢者診療でも，医学的適応の熟考および価値観の多様性に対する理解は大切である！

参考文献

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2）Field TS, et al：Risk factors for adverse drug events among nursing home residents. Arch Intern Med 161：1629-1634, 2001

3）O'Mahony D, et al：STOPP/START criteria for potentially inappropriate prescribing in older people；Version 2. Age Ageing 44：213-218, 2015

4）The American Geriatrics Society 2015 Beers Criteria Update Expert Panel：American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 63：2227-2246, 2015

5）Verdoorn S, et al：Majority of drug-related problems identified during medication review are not associated with STOPP/START criteria. Eur J Clin Pharmacol 71：1255-1262, 2015

6）Frankenthal D, et al：Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility；A randomized clinical trial. J Am Geriatr Soc 62：1658-1665, 2014

7）Hanlon JT, et al：A method for assessing drug therapy appropriateness. J Clin Epidemiol 45：1045-1051, 1992

8）北　和也：そもそも“ナゾ処方”とは？　不適切処方をしない/放置しないための8箇条．総合診療26：451-458, 2016

9）Scott IA：Reducing inappropriate polypharmacy；The process of deprescribing. JAMA Intern Med 175：827-834, 2015

10）Araki A, et al：Long-term multiple risk factor interventions in Japanese elderly diabetic patients；The Japanese Elderly Diabetes Intervention Trial-study design, baseline characteristics and effects of intervention. Geriatr Gerontol Int 12（Suppl 1）：7-17, 2012

11）高齢者糖尿病の治療向上のための日本糖尿病学会と日本老年医学会の合同委員会：高齢者糖尿病の血糖コントロール目標について（HbA1c値），日本糖尿病学会，2016　http://www.jds.or.jp/modules/important/index.php?page=article＆storyid=66（2016年6月28日閲覧）

12）Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program（SHEP）. SHEP Cooperative Research Group. JAMA 265：3255-3264, 1991

13）Benetos A, Rossignol P：Measurement methodology；What does blood pressure mean in the PARTAGE study?-reply. JAMA Intern Med 175：1860, 2015

14）US Preventive Services Task Force：Certain At-risk Patients Can Benefit From Statin Use, 2015　http://www.aafp.org/news/health-of-the-public/20151223uspstfcvd-lipids.html（2016年6月28日閲覧）

15）Kutner JS, et al：Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness；A randomized clinical trial. JAMA Intern Med 175：691-700, 2015

16）Moss AH, et al：Prognostic significance of the “surprise” question in cancer patients. J Palliat Med 13：837-840, 2010