進階搜尋


   電子論文尚未授權公開,紙本請查館藏目錄
(※如查詢不到或館藏狀況顯示「閉架不公開」,表示該本論文不在書庫,無法取用。)
系統識別號 U0026-1002201522554900
論文名稱(中文) 周全性高齡藥事照護使用於內科老年住院病患之探討
論文名稱(英文) Comprehensive geriatric pharmaceutical care among hospitalized elderly patients
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 103
學期 1
出版年 104
研究生(中文) 郭建宏
研究生(英文) Jiann-Horng Kuo
學號 tc6011036
學位類別 碩士
語文別 中文
論文頁數 102頁
口試委員 口試委員-盧豐華
指導教授-張家銘
口試委員-歐凰姿
中文關鍵字 老年病症候群  周全性老年醫學評估  不適當用藥  多重用藥 
英文關鍵字 geriatric syndromes  comprehensive geriatric assessment  inappropriate prescription  polypharmacy 
學科別分類
中文摘要 研究背景:
多數高齡患者因為生理退化、日常生活功能降低、患有多重疾病並合併服用多種藥物的情況,同時伴隨心理層面及家庭社會支持功能的不足,進而延伸出許多用藥上的問題。尤其當高齡者合併老年病症候群的出現,讓藥物的使用需更加謹慎考量。
目的:
觀察使用周全性高齡藥事照護評估實際於病房訪視與否,所發現高齡患者臨床潛在用藥問題類型的差異性。
方法:
本研究個案收集自2014年9月至12月於臺灣南部某一醫學中心老年科病房及一般內科病房,分別為高齡藥事組與一般藥事組,各收案120位65歲以上患者,於徵求同意後進行收案。高齡藥事組訪視流程為:(1) 電子病歷紀綠及臨床訪視藥事照護評估;(2)STOPP&START評估;(3)藥物問題匯整;(4)與老年醫療團隊成員討論。一般藥事組訪視流程則在電腦端進行:(1)電子病歷紀錄藥事照護評估;(2) STOPP&START評估;(3)藥物問題匯整。並比較高齡藥事組與一般藥事組的用藥問題類型,本研究分為11項問題類型與2項衛教類型。
研究結果:
研究共收案240位病人,平均年齡為81.5歲,男性占48%。其主要住院原因為發燒、呼吸困難、肢體疼痛,常見疾病之診斷分別為高血壓、慢性腎衰竭及糖尿病,每位病患疾病平均診斷數是5.1種。高齡藥事組與一般藥事組兩組分別使用1547筆與1412筆藥物。平均每位病人使用過之藥物分別為12.9±5.5筆與11.8±5.4筆。二組分別發現75筆與28筆藥事照護相關問題,高齡藥事組75筆問題中,需經過實際臨床訪視才能發現者為45筆,另外還有27筆衛教藥物相關問題。問題類型中數量最多者為目前無使用必要性,其次是磨粉使用不宜磨粉藥物,接著是腎功能不佳須向醫師提出藥物劑量調整或不建議使用、追踨檢驗值。高齡藥事組透過臨床訪視才能發現的問題有合理劑量調整、譫妄評估、臨床效益有限且難以評估、藥物使用適當性、用法有疑義、原已長期使用,也需續用,但住院未開立之藥物,高齡藥事組需要進行衛教的部分則為藥物遵醫囑性不佳與無法正確執行用藥。
依據潛在不適當用藥(STOPP)準則,共發現高齡藥事組與一般藥事組分別36位病患有49件與21位病患有23件潛在不適當用藥問題,其中數量最多者為使用鈣離子阻斷劑於慢性便秘患者、其次為患有出血疾患者使用Aspirin、Clopidogrel、Dipyridamole及Warfarin、在過去三個月曾有過1次以上的跌倒經驗,同時期使用了易導致老人跌倒之藥物BZD(Benzodiazepine)類藥物。依據潛在應建議開立藥物(START)準則,發現15位病患有20件與23位病患有32件建議應開立處方。
結論:
「周全性高齡藥事照護評估表」可用於多重疾患之高齡病患進行臨床藥物評估,能發現較多潛在藥物相關問題。以高齡臨床藥事照護流程來評估住院高齡病患,所發現之多種藥物問題,經由與醫師討論後的建議,可為高齡者住院患者降低潛在用藥問題與風險。


英文摘要 Summary
Using method of the comprehensive geriatric pharmaceutical care group (CGPC) as the research framework, this research aimed: to compare difference of medication problems among elderly patients that were either visited directly by pharmacists using comprehensive geriatric pharmaceutical assessment or not. Our study found that medication problems in elderly, including the geriatric syndrome and recommended to the geriatric medical team for the discussion and then applied it to patients. To reduce problems and risk of medication .

Introduction
Because of age-related physiological changes, decline in activities of daily living, multiple comorbid diseases with polypharmacy, as well as psychological conditions and lack support from family and society, medication prolems become more complex. When geriatric syndrome occurs, the consideration of medication use must be more serious.

Methods
From September to December 2014, patients aged ≧65 years hospitalized to geriatric ward and general medical ward of a medical center in southern Taiwan, were recruited. By dividing into the intervention group with comprehensive pharmaceutical care in geriatric ward and the control group with routine pharmaceutical care in the general medical ward, a total of 240 patients (120 each) with informed consents will be enrolled. The process of clinic visits included: (1) To record the admission medications and comprehensive geriatric assessment; (2) To clarify STOPP and START criteria assessment; (3) To collect pharmaceutical care problem; (4) To discuss with geriatric team members. Medication problems were compared between intervention group and control group, of which conditions and medications were reviewed on the computer system in hospital.

Results
Among 240 enrolled individuals, their mean age was 81.5 years , 48% were male. The reasons of hospitalization were fever, dyspnea and limb pain. The most common diagnoses of diseases were hypertension, chronic kidney disease and diabetes mellitus, with an average of 5.1 diagnoses per patient. Numbers of prescribed medications among comprehensive geriatric pharmaceutical care group (CGPC) and general pharmaceutical care group (GPC) were 1547 and 1412, with averages of 12.9±5.5 and 11.8±5.4 medications, respectively. A total of 75 and 28 among the CGPC and GPC groups, respectively. Among CGPC cases, 45 medication problems were found by clinic visit. Overall, the most common types of medication problems were unnecessary medication use, non-crushed medications, dosage adjustment for renal impairment, not recommended for renal impairement, medication related laboratory data to be followed up.
The 45 CGPC medication problems found by clinic visit included general dosage adjustment, delirium assessment, limited clinical benefit, inappropriate use, questionable usage of medications, previous medications needed to be continued but not prescribed after admission. Medication education for patients were poor adherence to medication use and use of medications incorrect. By STOPP criteria, 36 CGPC cases and the 21 GPC cases had been prescribed 49 and 23 inappropriate medications, respectively. Overall, most common STOPP medications were calcium channel blockers in patients with chronic constipation, aspirin, clopidogrel, dipyridamole or warfarin in patients with concurrent bleeding disorder, benzodiazepines and first generation antihistamines in patients who are prone to falls. By START criteria, 15 CGPC cases and 23 GPC cases had 20 and 32 potential medications to be suggested to initiate.

Conclusion
Comprehensive geriatric pharmaceutical care might be used to evaluate a variety of potential medication problems among hospitalized elderly patients with multi-comorbidities. After further discussion with physicians, such problems and risk of medication use might be reduced among hospitalized elderly patients.
論文目次 摘要......... I
Abstract......... III
誌謝......... VI
第一章 背景 1
第一節 老年人的生理變化與藥物影響 1
第二節 周全性評估與藥物 2
第三節 住院的周全藥事照護模式 3
第二章 研究動機與目的 5
第一節 研究動機 5
第二節 研究目的 5
第三章 文獻回顧 6
第一節 高齡者用藥問題 6
第二節 老年病症候群與藥物的相關性 7
第三節 周全性老年評估 17
第四節 藥師職責 18
第五節 目前一般藥事照護 20
第六節 高齡病患相關的藥事照護 22
第一項 常見藥物不適當評估工具介紹 24
第二項 藥物遵醫囑性 26
第三項 藥物代謝器官評估 27
第四項 磨粉使用不宜磨粉藥物 28
第五項 活動功能不佳者之藥物調整 29
第六項 預期餘命不長者之用藥調整 30
第四章 研究方法 33
第一節 本研究名詞定義 33
第二節 研究設計 36
第三節 研究對象 37
第四節 研究工具 38
第五節 藥事照護研究流程圖 39
第六節 周全性高齡藥事照護評估內容 42
第一項 基本資料 42
第二項 用藥史與疾病照護問題 42
第三項 綜合藥物評估與討論建議評估 44
第七節 潛在不適當用藥與建議使用藥物評估 45
第八節 統計方法 46
第五章 結果 48
第一節 研究對象排除 48
第二節 研究對象之人口學分析 49
第三節 用藥問題呈現 53
第四節 臨床訪視呈現之用藥問題 58
第一項 無管路,不宜磨粉藥物磨粉使用 60
第二項 目前無使用必要性 60
第三項 合理劑量調整 61
第四項 譫妄評估 61
第五項 臨床效益有限且難以評估 61
第六項 藥物使用適當性 61
第七項 用法有疑義 61
第八項 原已長期使用,也需續用,但住院未開立之藥物 62
第九項 藥物遵醫囑性不佳 62
第十項 無法正確執行用藥 62
第五節 STOPP &START呈現之用藥問題 63
第六節 老年病症候群與用藥問題之相關 65
第七節 藥物衛教相關問題 66
第六章 討論 68
第一節 本研究特點 68
第二節 用藥問題與藥物相關性 70
第三節 常見藥物不適當用法 75
第四節 研究限制與未來期許 77
第五節 未來研究方向 79
第七章 參考資料 81
附錄一 周全性高齡藥事照護評估表 91
附錄二 同意人體研究證明書 95
附錄三 老年潛在不適當藥物準則 96
附錄四 人體研究說明及同意書 99

參考文獻 網址與書籍
衛生福利部國民健康署年報(2013)
http://hps.giee.ntnu.edu.tw/FileUpload/POL/F_201406261102396703.pdf
Introduction to Drug Utilization Research (2003). Retrieved January 06, 2015, from:
http://apps.who.int/medicinedocs/pdf/s4876e/s4876e.pdf
Tatro, D. S. (2009) Drug Interaction Facts: 2009 Edition. Facts and Comparisons.
Halter JB. Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S(1999): Hazzard’s geriatric medicine and gerontology, 6th Edition
中文文獻
李怡婷(2007)藥師詢問病患用藥史對發掘藥品相關問題之貢獻:以腎臟科病房為例.台灣大學臨床藥理研究所學位論文, 1-53
李惠娟,高淑敏,林永順,葉鳳英,張慧真,&周辰熹.(2010).藥品警訊系統及處方評估訓練應用於新進藥師. 臺灣醫學, 14(5), 479-484.
李季黛等(2013).藥舞長安-高齡長者藥事服務. 藥學雜誌,29(4)148-151.
周玟觀(2014).周全性高齡藥事照護用於老年科住院病患之初探. 成功大學老年學研究所學位論文, 1-83.
胡芳文, 陳清惠, & 張家銘. (2013). 以實證探討住院老人移除留置尿管處理方案.台灣老年醫學暨老年學雜誌, 8(1), 1-13.
張家銘 & 蔡智能. (2003).老年人之周全性評估. 臺灣醫學, 7(3), 364-374.
譚延輝.(2010).藥事照護執行規範.藥學雜誌,26:S33-S38.
英文文獻
Abrams P., Blaivas J.G, StantonnS.L., et al (1988).Standardization of terminology of lower urinary tract function. Neurourol Urodyn 7, 403-427
Abrams, W. B., Beers, M. H., & Berkow, R. (1995). The Merck Manual of Geriatrics. Merck Research Laboratories, Whitehouse Station (NJ).
Agostini, J. V., Leo-Summers, L. S., & Inouye, S. K. (2001). Cognitive and other adverse effects of diphenhydramine use in hospitalized older patients. Archives of Internal Medicine, 161(17), 2091-2097.
Almeida, O. P., & Almeida, S. A. (1999). Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD‐10 and DSM‐IV. International Journal of Geriatric Psychiatry, 14(10), 858-865.
Ambrose P, Winter ME. Vancomycin. In: Winter ME, editor.(2004). Basic Clinical Pharmacokinetics. 4. Philadelphia: Lippincott Williams & Wilkins; pp. 451–476.
American Geriatrics Society 2012 Beers Criteria Update Expert Panel. (2012). American geriatrics society updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society,60(4), 616.
Anderson, S., Eldadah, B., Halter, J. B., Hazzard, W. R., Himmelfarb, J., Horne, F. M., & High, K. P. (2011). Acute kidney injury in older adults. Journal of the American Society of Nephrology, 22(1), 28-38.
Ansell, J. E., Kumar, R., & Deykin, D. (1977). The spectrum of vitamin K deficiency. JAMA, 238(1), 40-42.
Applegate, W. B., Blass, J. P., & Williams, T. F. (1990). Instruments for the functional assessment of older patients. New England Journal of Medicine, 322(17), 1207-1214.
Ben Natan, M., Garfinkel, D., & Shachar, I. (2010). End-of-life needs as perceived by terminally ill older adult patients, family and staff. European Journal of Oncology Nursing, 14(4), 299-303
Bladh, L., Ottosson, E., Karlsson, J., Klintberg, L., & Wallerstedt, S. M. (2011). Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial. BMJ Quality & Safety, qshc-2009.
Brooks, T. L., Leventhal, H., Wolf, M. S., O’Conor, R., Morillo, J., Martynenko, M., & Federman, A. D. (2014). Strategies used by older adults with asthma for adherence to inhaled corticosteroids. Journal of General Internal Medicine,29(11), 1506-1512.
Campbell, A. J., Robertson, M. C., Gardner, M. M., Norton, R. N., & Buchner, D. M. (1999). Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. Journal of the American Geriatrics Society, 47(7), 850-853.
Campbell, T. L. (1986). Family's impact on health: A critical review. Family Systems Medicine, Vol 4(2-3), 135-328.
Caplan, G. A., Williams, A. J., Daly, B., & Abraham, K. (2004). A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department—the DEED II study. Journal of the American Geriatrics Society, 52(9), 1417-1423.
Chan, D. C., Chen, J. H., Kuo, H. K., We, C. J., Lu, I. S., Chiu, L. S., & Wu, S. C. (2012). Drug-related problems (DRPs) identified from geriatric medication safety review clinics. Archives of Gerontology and Geriatrics, 54(1), 168-174.
Chang, H. H., Tsai, S. L., Chen, C. Y., & Liu, W. J. (2010). Outcomes of hospitalized elderly patients with geriatric syndrome: report of a community hospital reform plan in Taiwan. Archives of Gerontology and Geriatrics, 50, S30-S33.
Chan, D. Hao, Y. T., & Wu, S. C. (2009). Characteristics of outpatient prescriptions for frail taiwanese elders with long‐term care needs. Pharmacoepidemiology and Drug Safety, 18(4), 327-334
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40(5), 373-383.
Chen, H. Y., Tang, C. C., Wang, Y. C., Tsai, P. Y., & Huang, L. H. (2014). Efficacy of Pharmaceutical Care in Hemodialysis Patients-A Double-Blind, Randomized, Controlled Trial. The Journal of Taiwan Pharmacy, 30(2).
Chisholm-Burns, M. A., Lee, J. K., Spivey, C. A., Slack, M., Herrier, R. N., Hall-Lipsy, E., & Wunz, T. (2010). US pharmacists' effect as team members on patient care: systematic review and meta-analyses. Medical Care, 48(10), 923-933.
Chong, M. Y., Tsang, H. Y., Chen, C. S., Tang, T. C., Chen, C. C., Yeh, T. L., & Lo, H. Y. (2001). Community study of depression in old age in taiwan prevalence, life events and socio-demographic correlates. The British Journal of Psychiatry, 178(1), 29-35.
Cole, M. G. (2004). Delirium in elderly patients. The American Journal of Geriatric Psychiatry, 12(1), 7-21.
Cole, M. G., Ciampi, A., Belzile, E., & Zhong, L. (2009). Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age and Ageing, 38(1), 19-26.
Costa-Dias, M. J., Oliveira, A. S., Martins, T., Araújo, F., Santos, A. S., Moreira, C. N., & José, H. (2014). Medication fall risk in old hospitalized patients: A retrospective study. Nurse Education Today, 34(2), 171-176.
Cusack, S., Day, M. R., Wills, T., & Coffey, A. (2012). Older people and laxative use: comparison between community and long-term care settings. British Journal of Nursing, 21(12), 711-717.
Deng, D. Y. (2011). Urinary incontinence in women. Medical Clinics of North America, 95(1), 101-109.
Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613-619.
Derubeis, R. J., Evans, M. D., Hollon, S. D., Garvey, M. J., Grove, W. M., & Tuason, V. B. (1990). How does cognitive therapy work? cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression. Journal of Consulting and Clinical Psychology, 58(6), 862.
Diokno, A. C., Brown, M. B., & Herzog, A. R. (1991). Relationship between use of diureticsand continence status in the elderly. Urology, 38(1), 39-42.
Djernes, J. K. (2006). Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatrica Scandinavica, 113(5), 372-387.
Eleazer, G. P., McRae, T., Knebl, J., Reuben, D., Sullivan, G., Thompson, B., & Dupee, R. (2000). Core competencies for the care of older patients: Recommendations of the American Geriatrics Society. Academic Medicine,75(3), 252-255.
Elliott, M. R. A., Martinac, G., Campbell, S., Thorn, J., & Woodward, M. C. (2012). Pharmacist-led medication review to identify medication-related problems in older people referred to an aged care assessment team. Drugs & Aging, 29(7), 593-605.
Ellis, G., & Langhorne, P. (2005). Comprehensive geriatric assessment for older hospital patients. British Medical Bulletin, 71(1), 45-59.
Ellison, L. F., & Morrison, H. I. (2001). Low serum cholesterol concentration and risk of suicide. Epidemiology, 12(2), 168-172.
Engelborghs, S., Maertens, K., Nagels, G., Vloeberghs, E., Mariën, P., Symons, A., & De Deyn, P. P. (2005). Neuropsychiatric symptoms of dementia: cross‐sectional analysis from a prospective, longitudinal Belgian study. International Journal of Geriatric Psychiatry, 20(11), 1028-1037.
Ensrud, K. E., Blackwell, T. L., Ancoli-Israel, S., Redline, S., Cawthon, P. M., Paudel, M. L., & Stone, K. L. (2012). Sleep disturbances and risk of frailty and mortality in older men. Sleep Medicine, 13(10), 1217-1225.
Fertleman, M., Barnett, N., & Patel, T. (2005). Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds. Quality and Safety in Health Care, 14(3), 207-211.
Fox, C., Smith, T., Maidment, I., Chan, W. Y., Bua, N., Myint, P. K., & Campbell, N. (2014). Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review.Age and Ageing, 43(5), 604-615.
Frankenthal, D., Lerman, Y., Kalendaryev, E., & Lerman, Y. (2013). Potentially inappropriate prescribing among older residents in a geriatric hospital in Israel. International Journal of Clinical Pharmacy, 35(5), 677-682.
Frankenthal, D., Lerman, Y., Kalendaryev, E., & Lerman, Y. (2014). 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. Journal of the American Geriatrics Society, 62(9), 1658-1665.
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., & McBurnie, M. A. (2001). Frailty in older adults evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3),M146-M157.
Frier, B. M., & Scott, R. D. (1976). Osteomalacia and arthropathy associated with prolonged abuse of purgatives. The British Journal of Clinical Practice, 31(1-3), 17-19.
Fu, H., Xie, W., Curtis, B., & Schuster, D. (2014). Identifying factors associated with hypoglycemia-related hospitalizations among elderly patients with T2DM in the US: a novel approach using influential variable analysis. Current Medical Research and Opinion, (0), 1-27.
Fulton, M. M., & Riley Allen, E. (2005). Polypharmacy in the elderly: a literature review. Journal of the American Academy of Nurse Practitioners, 17(4), 123-132.
Fugate Woods, N., LaCroix, A. Z., Gray, S. L., Aragaki, A., Cochrane, B. B., Brunner, R. L., & Newman, A. B. (2005). Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. Journal of the American Geriatrics Society, 53(8), 1321-1330.
Gallegos-Orozco, J. F., Foxx-Orenstein, A. E., Sterler, S. M., & Stoa, J. M. (2011). Chronic constipation in the elderly. The American Journal of Gastroenterology, 107(1), 18-25.
Garfinkel, D., Zur-Gil, S., & Ben-Israel, H. (2007). The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people. IMAJ-RAMAT GAN, 9(6), 430.
Garfinkel, D., & Mangin, D. (2010). Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Archives of Internal Medicine, 170(18), 1648-1654.
Gillespie, U., Alassaad, A., Henrohn, D., Garmo, H., Hammarlund-Udenaes, M., Toss, H., & Mörlin, C. (2009). A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Archives of Internal Medicine, 169(9), 894-900.
Gnjidic, D., & Johnell, K. (2013). Clinical implications from drug–drug and drug–disease interactions in older people. Clinical and Experimental Pharmacology and Physiology, 40(5), 320-325.
Gordon, S. F., Dainty, C., & Smith, T. (2012). Why and when to withdraw drugs in the elderly and frail. Prescriber, 23(11), 47-51.
Gouin-Thibault, I., Pautas, E., Mahé, I., Descarpentries, C., Nivet-Antoine, V., Golmard, J. L., & Siguret, V. (2007). Is modification of diet in renal disease formula similar to Cockcroft–Gault formula to assess renal function in elderly hospitalized patients treated with low-molecular-weight heparin? The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62(11), 1300-1305.
Hajjar, E. R., Hanlon, J. T., Sloane, R. J., Lindblad, C. I., Pieper, C. F., Ruby, C. M., & Schmader, K. E. (2005). Unnecessary drug use in frail older people at hospital discharge. Journal of the American Geriatrics Society, 53(9), 1518-1523
Hajjar, Emily R., Angela C. Cafiero, and Joseph T. Hanlon. Polypharmacy in elderly patients. The American Journal of Geriatric Pharmacotherapy 5.4 (2007): 345-351.
Hanlon, J. T., Shimp, L. A., & Semla, T. P. (2000). Recent advances in geriatrics: drug-related problems in the elderly. Annals of Pharmacotherapy,34(3), 360-365.
Hanssens, Y., Woods, D., Alsulaiti, A., Adheir, F., Al-Meer, N., & Obaidan, N. (2006). Improving oral medicine administration in patients with swallowing problems and feeding tubes. Annals of Pharmacotherapy, 40(12), 2142-2147.
Hannou et al.,(2014).CP-076 Effects of pharmacist interventions on inappropriate prescribing in a geriatric psychiatry unit. European Journal of Hospital Pharmacy: Science and Practice, 21(Suppl 1), A31-A31.
Heller, C. A., & Friedman, P. A. (1983). Pyridoxine deficiency and peripheral neuropathy associated with long-term phenelzine therapy. The American Journal of Medicine, 75(5), 887-888.
Hepler, C. D., & Strand, L. M. (1990). Opportunities and responsibilities in pharmaceutical care. American Journal Hospital Pharmacy, 47(3), 533-543.
Hill‐Taylor, B., Sketris, I., Hayden, J., Byrne, S., O'Sullivan, D., & Christie, R. (2013). Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. Journal of Clinical Pharmacy and Therapeutics, 38(5), 360-372.
Hilmer, S. N., Gnjidic, D., & Abernethy, D. R. (2012). Pharmacoepidemiology in the postmarketing assessment of the safety and efficacy of drugs in older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 67(2), 181-188.
Holmes, H. M., Hayley, D. C., Alexander, G. C., & Sachs, G. A. (2006). Reconsidering medication appropriateness for patients late in life. Archives of Internal Medicine, 166(6), 605-609.
Hoogerduijn, J. G., Schuurmans, M. J., Duijnstee, M. S., De Rooij, S. E., & Grypdonck, M. F. (2007). A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. Journal of Clinical Nursing, 16(1), 46-57.
Hruschak, J. (1996). Urinary Incontinence in Adults: Acute and Chronic Management. AORN Journal, 64(5), 823-824.
Hshieh, T. T., Fong, T. G., Marcantonio, E. R., & Inouye, S. K. (2008). Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence.The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63(7), 764-772.
Inouye, S. K. (2006). Delirium in older persons. New England Journal of Medicine, 354(11), 1157-1165.
Inouye, S. K., Studenski, S., Tinetti, M. E., & Kuchel, G. A. (2007). Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. Journal of the American Geriatrics Society, 55(5), 780-791.
Jones, S. A., & Bhandari, S. (2013). The prevalence of potentially inappropriate medication prescribing in elderly patients with chronic kidney disease. Postgraduate Medical Journal, 89(1051), 247-250.
Juurlink, D. N., Mamdani, M., Kopp, A., Laupacis, A., & Redelmeier, D. A. (2003). Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA, 289(13), 1652-1658.
Kaplowitz, N. (2004). Drug-induced liver injury. Clinical Infectious Diseases,38(Supplement 2), S44-S48.
Kassam, R., Collins, J. B., & Berkowitz, J. (2012). Patient satisfaction with pharmaceutical care delivery in community pharmacies. Patient Preference and Adherence, 6, 337.
Kaur, S., Roberts, J. A., & Roberts, M. S. (2012). Evaluation of medication-related problems in medication reviews: a comparative perspective. Annals of Pharmacotherapy, 46(7-8), 972-982.
Kirby,R.(2013).Management of lower urinary tract symptoms in BPH.Prescriber, 24(21), 21-27.
King, B. D. (2006). Functional decline in hospitalized elders. Medsurg Nursing,15(5), 265.
Krska, J., Cromarty, J. A., Arris, F., Jamieson, D., Hansford, D., Duffus, P. R., & Seymour, D. G. (2001). Pharmacist‐led medication review in patients over 65: a randomized, controlled trial in primary care. Age and Ageing, 30(3), 205-211.
Landefeld, C. S., Bowers, B. J., Feld, A. D., Hartmann, K. E., Hoffman, E., Ingber, M. J., & Trock, B. J. (2008). National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Annals of Internal Medicine, 148(6), 449-458.
Landi, F., Cesari, M., Russo, A., Onder, G., Sgadari, A., & Bernabei, R. (2002). Benzodiazepines and the risk of urinary incontinence in frail older persons living in the community. Clinical Pharmacology & Therapeutics, 72(6), 729-734.
Larsen, P. D., & Martin, J. L. H. (1999). Polypharmacy and elderly patients. Aorn Journal, 69(3), 619-628
Lee, J. K., Slack, M. K., Martin, J., Ehrman, C., & Chisholm‐Burns, M. (2013). Geriatric patient care by US pharmacists in healthcare teams: systematic review and meta‐analyses. Journal of the American Geriatrics Society, 61(7), 1119-1127.
Lin, C. C., Bai, Y. M., Chen, J. Y., Lin, C. Y., & Lan, T. H. (1999). A retrospective study of clozapine and urinary incontinence in Chinese in‐patients. Acta Psychiatrica Scandinavica, 100(2), 158-161.
Lindeman, R. D., & Goldman, R. (1986). Anatomic and physiologic age changes in the kidney. Experimental Gerontology, 21(4), 379-406.
Liu, C. L., Peng, L. N., Chen, Y. T., Lin, M. H., Liu, L. K., & Chen, L. K. (2012). Potentially inappropriate prescribing (IP) for elderly medical inpatients in taiwan: a hospital-based study. Archives of Gerontology and Geriatrics, 55(1), 148-151.
Llor, C., Bayona, C., Hernandez, S., Moragas, A., & Miravitlles, M. (2012). Comparison of adherence between twice‐and thrice‐daily regimens of oral amoxicillin/clavulanic acid. Respirology, 17(4), 687-692.
Maffioli, P., & Derosa, G. (2014). Hypoglycemia, its implications in clinical practice, and possible ways to prevent it. Current Medical Research & Opinion,30(5), 771-773.
Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety, 13(1), 57-65.
Malhotra, C., Chan, A., Matchar, D., Seow, D., Chuo, A., & Do, Y. K. (2013). Diagnostic performance of short portable mental status questionnaire for screening dementia among patients attending cognitive assessment clinics in Singapore. Annals of the Academy of Medicine Singapore, 42, 15-19.
Marshall, H. J., & Beevers, D. G. (1993). Alpha-adrenergic blockade and urinary incontinence. Journal of Hypertension, 11(10), 1152-1153.
Merchant, R. A., Li, B., Yap, K. B., & Ng, T. P. (2009). Use of drugs with anticholinegic effects and cognitive impairment in community-living older persons. Age and Ageing, 38(1), 105-108.
Mikeal, R. L., Brown, T. R., Lazarus, H. L., & Vinson, M. C. (1975). Quality of pharmaceutical care in hospitals. American Journal of Hospital Pharmacy, 32(6), 567-74.
Milos, V., Bondesson, Å., Magnusson, M., Jakobsson, U., Westerlund, T., & Midlöv, P. (2014). Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatrics, 14(1), 40.
Navarro, V. J., & Senior, J. R. (2006). Drug-related hepatotoxicity. New England Journal of Medicine, 354(7), 731-739.
Nobili, A., Garattini, S., & Mannucci, P. M. (2011). Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. Journal of Comorbidity, 1(1), 28-44
Ogawa, R., & Echizen, H. (2011). Clinically significant drug interactions with antacids. Drugs, 71(14), 1839-1864.
O'Keeffe, S. T., & Lavan, J. N. (1999). Clinical significance of delirium subtypes in older people. Age and Ageing, 28(2), 115-119.
O’Mahony, D., Gallagher, P., Ryan, C., Byrne, S., Hamilton, H., Barry, P., & Kennedy, J. (2010). STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age. European Geriatric Medicine,1(1), 45-51.
O'Mahony, D., & O'Connor, M. N. (2011). Pharmacotherapy at the end-of-life. Age and Ageing, 40(4), 419-422.
O'Mahony, D., O'Sullivan, D., Byrne, S., O'Connor, M. N., Ryan, C., & Gallagher, P. (2014). STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age and Ageing, afu145.
Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353(5), 487-497
Paparella, S. (2010). Identified safety risks with splitting and crushing oral medications. Journal of Emergency Nursing, 36(2), 156-158.
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). Servqual. Journal of Retailing, 64(1), 12-40.
Patten, S. B., & Barbui, C. (2004). Drug-induced depression: a systematic review to inform clinical practice. Psychotherapy and Psychosomatics, 73(4), 207-215.
Petrone, K., & Katz, P. (2005). Approaches to appropriate drug prescribing for the older adult. Primary Care: Clinics in Office Practice, 32(3), 755-775.
Pierre, J. M. (2005). Extrapyramidal symptoms with atypical antipsychotics. Drug Safety, 28(3), 191-208。
Phillips, M. S., Gayman, J. E., & Todd, M. W. (1996). ASHP guidelines on medication-use evaluation. American Society of Health-system Pharmacists.American Journal of Health-System Pharmacy, 53(16), 1953-1955
Qato, D. M., Alexander, G. C., Conti, R. M., Johnson, M., Schumm, P., & Lindau, S. T. (2008). Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA, 300(24), 2867-2878.
Rollason, V., & Vogt, N. (2003). Reduction of polypharmacy in the elderly. Drugs & Aging, 20(11), 817-832.
Romano, P. S., Roos, L. L., & Jollis, J. G. (1993). Presentation adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. Journal of Clinical Epidemiology, 46(10), 1075-1079Ryan, C., O'Mahony, D., & Byrne, S. (2009). Application of STOPP and START criteria: interrater reliability among pharmacists. Annals of Pharmacotherapy,43(7-8), 1239-1244.
Rose, J. H., Bowman, K. F., & Kresevic, D. (2000). Nurse versus family caregiver perspectives on hospitalized older patients: an exploratory study of agreement at admission and discharge. Health Communication, 12(1), 63-80)
Rothberg, M. B., Herzig, S. J., Pekow, P. S., Avrunin, J., Lagu, T., & Lindenauer, P. K. (2013). Association between sedating medications and delirium in older inpatients. Journal of the American Geriatrics Society, 61(6), 923-930.
Ruiz et al (2014). PS-089 Medicines reconciliation and medication review in elderly polymedicated patients at hospital admission. European Journal of Hospital Pharmacy: Science and Practice, 21(Suppl 1), A179-A179.
Ryan, C., O'Mahony, D., & Byrne, S. (2009). Application of STOPP and START criteria: interrater reliability among pharmacists. Annals of Pharmacotherapy, 43(7), 1239-44.
Saka, B., Kaya, O., Ozturk, G. B., Erten, N., & Karan, M. A. (2010). Malnutrition in the elderly and its relationship with other geriatric syndromes.Clinical Nutrition, 29(6), 745-748.
Samsa, G. P., Hanlon, J. T., Schmader, K. E., Weinberger, M., Clipp, E. C., Uttech, K. M., & Cohen, H. J. (1994). A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity. Journal of Clinical Epidemiology, 47(8), 891-896.
Scott, I., & Jayathissa, S. (2010). Quality of drug prescribing in older patients: is there a problem and can we improve it? Internal Medicine Journal, 40(1), 7-18.
Simonson, W., & Feinberg, J. L. (2005). Medication-related problems in the elderly. Drugs & Aging, 22(7), 559-569.
Society, A. G., Society, G., Of, A. A., Prevention, O. F., & Panel, O. S. (2001). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 49(5), 664-672.
Sonn, U., & Asberg, K. H. (1990). Assessment of activities of daily living in the elderly. A study of a population of 76-year-olds in Gothenburg, Sweden. Scandinavian Journal of Rehabilitation Medicine, 23(4), 193-202.
Sosa-Ortiz, A. L., Acosta-Castillo, I., & Prince, M. J. (2012). Epidemiology of dementias and Alzheimer’s disease. Archives of Medical Research, 43(8), 600-608.
Spillman, B. C. (2004). Changes in elderly disability rates and the implications for health care utilization and cost. Milbank Quarterly, 82(1), 157-194.
Steffens, D. C., Skoog, I., Norton, M. C., Hart, A. D., Tschanz, J. T., Plassman, B. L., & Breitner, J. C. (2000). Prevalence of depression and its treatment in an elderly population: the cachecounty study. Archives of General Psychiatry, 57(6), 601-607.
Stegemann, S., Ecker, F., Maio, M., Kraahs, P., Wohlfart, R., Breitkreutz, J., & Broegmann, B. (2010). Geriatric drug therapy: neglecting the inevitable majority. Ageing Research Reviews, 9(4), 384-398.
Tinetti, M. E. (2003). Preventing falls in elderly persons. New England Journal of Medicine, 348(1), 42-49.
Thomsen, T. W., Shaffer, R. W., & Setnik, G. S. (2006). Nasogastric intubation. New England Journal of Medicine, 354(17).
Tschanz, C., Stargel, W. W., & Thomas, J. A. (1996). Interactions between drugs and nutrients. Advances in Pharmacology, 35, 1-26.
Van Mil, J. F., Schulz, M., & Tromp, T. F. D. (2004). Pharmaceutical care, European developments in concepts, implementation, teaching, and research: a review. Pharmacy World and Science, 26(6), 303-311.
Vermeeren, A. (2004). Residual effects of hypnotics. CNS Drugs, 18(5), 297-328.
Walston, J., McBurnie, M. A., Newman, A., Tracy, R. P., Kop, W. J., Hirsch, C. H., & Fried, L. P. (2002). Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the cardiovascular health study. Archives of Internal Medicine, 162(20), 2333-2341.
World Health Organization. (2000). Obesity: preventing and managing the global epidemic (No. 894). World Health Organization.
Wieland, D. (2003). The effectiveness and costs of comprehensive geriatric evaluation and management. Critical Reviews in Oncology/Hematology, 48(2), 227-237.
Wierenga, P. C., Buurman, B. M., Parlevliet, J. L., van Munster, B. C., Smorenburg, S. M., & Inouye, S. K. (2012). Association between acute geriatric syndromes and medication-related hospital admissions. Drugs and Aging, 29(8), 691-699.
Wilkins, R., & Adams, O. B. (1983). Health expectancy in Canada, late 1970s: demographic, regional, and social dimensions. American Journal of Public health, 73(9), 1073-1080.
Wou, F., Gladman, J. R., Bradshaw, L., Franklin, M., Edmans, J., & Conroy, S. P. (2013). The predictive properties of frailty-rating scales in the acute medical unit. Age and Ageing, 42(6), 776-781.
Wu, C. J. et al(2011). Factors affecting the burden on foreign caregivers of long-term disabled survivors in Taiwan. Taiwan Journal Physical Medicine and Rehabilitation, 39(1), 1-8.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17(1), 37-49.
Zarowitz, B. J., Stebelsky, L. A., Muma, B. K., Romain, T. M., & Peterson, E. L. (2005). Reduction of high‐risk polypharmacy drug combinations in patients in a managed care setting. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 25(11), 1636-1645.
Zhu, L. L., Xu, L. C., Wang, H. Q., Jin, J. F., Wang, H. F., & Zhou, Q. (2011). Appropriateness of administration of nasogastric medication and preliminary intervention. Therapeutics and Clinical Risk Management, 8, 393-401.
Zwygart-Stauffacher, M., Lindquist, R., & Savik, K. (2000). Development of health care delivery systems that are sensitive to the needs of stroke survivors and their caregivers. Nursing Administration Quarterly, 24(3), 33-42.
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2020-07-10起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw