Ness Jose, Hoth Angela, Barnett Mitchell J, Shorr Ronald I, Kaboli Peter J
Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa 52246, USA.
Am J Geriatr Pharmacother. 2006 Mar;4(1):42-51. doi: 10.1016/j.amjopharm.2006.03.008.
The use of drugs with anticholinergic adverse effects is often deemed inappropriate in elderly (aged > or = 65 years) patients, yet studies continue to show extensive use in this population at high risk for adverse drug events (ADEs). The burden of drug-related anticholinergic symptoms in community-dwelling elderly patients has not been well described.
The aim of this study was to assess the prevalence of anticholinergic symptoms, corresponding symptom burden, and anticholinergic-related ADEs in a sample of community-dwelling elderly veterans.
This prospective cohort study was conducted at the primary care clinics at the Veterans Affairs Medical Center (VAMC), Iowa City, Iowa. The study sample included randomly selected patients with intact cognitive function attending the VAMC and prescribed > or = 5 scheduled medications. Data on current prescription and nonprescription drug use were elicited by a trained research assistant and a clinical pharmacist from patient interviews and electronic medical records. The prevalence and severity of 7 anticholinergic symptoms (dry mouth, constipation, blurred vision, confusion, urinary hesitation, dry eyes, and drowsiness) were assessed at baseline. The occurrence of ADEs at 12 weeks was compared between patients using anticholinergic drugs and those not using them.
A total of 532 patients were included (97.9% men; mean age, 74.3 years; 27.1% used at least 1 anticholinergic drug). Twenty-two anticholinergic drugs (16 prescription medications, 6 over-the-counter medications) were identified. The mean number of anticholinergic symptoms was significantly higher in the group using anticholinergic drugs (3.1 vs 2.5; P < 0.01). However, only 2 symptoms were statistically more prevalent in the group using anticholinergic drugs: dry mouth (57.6% vs 45.6%) and constipation (42.4% vs 29.4%) (both, P < 0.01). At 12 weeks, only 1 (0.8%) patient in the group using anticholinergic drugs reported an ADE considered related to an anticholinergic drug.
Anticholinergic drug use was common (27.1%) in these elderly veterans with intact cognitive function. The mean number of anticholinergic symptoms was significantly greater in this group, and the prevalences of dry mouth and constipation were significantly higher in the group using anticholinergic drugs (all, P < 0.01). Anticholinergic-related ADEs were rare (0.8%). Although anticholinergic drugs should generally be avoided in the elderly, individual risks and benefits for a patient should be considered.
具有抗胆碱能不良反应的药物在老年（年龄≥65岁）患者中使用通常被认为是不合适的，但研究仍表明该人群广泛使用此类药物，且药物不良事件（ADEs）风险较高。社区居住老年患者中与药物相关的抗胆碱能症状负担尚未得到充分描述。
本研究旨在评估社区居住老年退伍军人样本中抗胆碱能症状的患病率、相应症状负担以及与抗胆碱能相关的药物不良事件。
这项前瞻性队列研究在爱荷华州爱荷华市退伍军人事务医疗中心（VAMC）的初级保健诊所进行。研究样本包括随机选择的认知功能完好、在VAMC就诊且开具≥5种定期服用药物的患者。由一名经过培训的研究助理和一名临床药剂师通过患者访谈和电子病历获取当前处方和非处方药物使用数据。在基线时评估7种抗胆碱能症状（口干、便秘、视力模糊、意识混乱、排尿犹豫、眼睛干涩和嗜睡）的患病率和严重程度。比较使用抗胆碱能药物的患者和未使用抗胆碱能药物的患者在12周时药物不良事件的发生情况。
共纳入532例患者（97.9%为男性；平均年龄74.3岁；27.1%使用至少1种抗胆碱能药物）。识别出22种抗胆碱能药物（16种处方药，6种非处方药）。使用抗胆碱能药物的组中抗胆碱能症状的平均数量显著更高（3.1比2.5；P<0.01）。然而，使用抗胆碱能药物的组中只有2种症状在统计学上更为普遍：口干（57.6%比45.6%）和便秘（42.4%比29.4%）（均P<0.01）。在12周时，使用抗胆碱能药物的组中只有1例（0.8%）患者报告了被认为与抗胆碱能药物相关的药物不良事件。
在这些认知功能完好的老年退伍军人中，抗胆碱能药物的使用很常见（27.1%）。该组中抗胆碱能症状的平均数量显著更多，且使用抗胆碱能药物的组中口干和便秘的患病率显著更高（均P<0.01）。与抗胆碱能相关的药物不良事件很少见（0.8%）。虽然一般应避免在老年人中使用抗胆碱能药物，但应考虑患者的个体风险和益处。
