Lowry Estelle, Woodman Richard J, Soiza Roy L, Mangoni Arduino A
Division of Applied Medicine, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
Hosp Pract (1995). 2011 Feb;39(1):30-6. doi: 10.3810/hp.2011.02.371.
Antimuscarinic drug prescribing scoring systems might better identify patients at risk of adverse drug reactions. The recently developed Anticholinergic Risk Scale (ARS) score is significantly associated with the number of antimuscarinic side effects in older outpatients. We sought to identify the clinical and demographic patient-level correlates of the ARS, including a modified version adjusted for daily dose, in elderly hospitalized patients.
Clinical and demographic patient characteristics known to be associated with antimuscarinic prescribing, ARS and dose-adjusted ARS scores, and full medication exposure on admission were recorded in 362 consecutive patients (aged 83.6 ± 6.6 years) admitted to 2 geriatric units (NHS Grampian, Aberdeen, Scotland, UK) between February 1, 2010 and June 30, 2010.
Each year of increasing age was associated with reduced number of antimuscarinic drugs (incidence rate ratio [IRR], 0.963; 95% confidence interval [CI], 0.948-0.980; P < 0.001), non-antimuscarinic drugs (IRR, 0.991; 95% CI, 0.985-0.997; P = 0.006), and total number of drugs (IRR, 0.988; 95% CI, 0.983-0.994; P < 0.001). Multivariate Poisson regression showed that increasing age and history of dementia were negatively associated with the ARS score (IRR, 0.97; 95% CI, 0.94-0.99; P = 0.001 and IRR, 0.62; 95% CI, 0.41-0.92; P = 0.019, respectively). By contrast, institutionalization (IRR, 1.32; 95% CI, 1.00-1.74; P = 0.050), Charlson comorbidity index (IRR, 1.06; 95% CI, 1.01-1.11; P = 0.015), and total number of non-antimuscarinic drugs (IRR, 1.13; 95% CI, 1.08-1.18; P < 0.001) were all positively associated with the ARS score. Similar results were observed for the dose-adjusted ARS score.
Institutionalization, comorbidities, and non-antimuscarinic polypharmacy show independent positive associations with the ARS and dose-adjusted ARS scores in older hospitalized patients. Increasing age and dementia are negatively associated with the ARS score.
抗毒蕈碱药物处方评分系统可能有助于更好地识别有药物不良反应风险的患者。最近开发的抗胆碱能风险量表（ARS）评分与老年门诊患者抗毒蕈碱副作用的数量显著相关。我们试图确定老年住院患者中ARS的临床和人口统计学相关因素，包括根据每日剂量调整的改良版。
在2010年2月1日至2010年6月30日期间，连续记录了入住英国苏格兰阿伯丁NHS Grampian的2个老年病房的362例患者（年龄83.6±6.6岁）的临床和人口统计学特征，这些特征已知与抗毒蕈碱药物处方、ARS和剂量调整后的ARS评分以及入院时的完整药物暴露情况有关。
年龄每增加一岁，抗毒蕈碱药物数量（发病率比[IRR]，0.963；95%置信区间[CI]，0.948 - 0.980；P < 0.001）、非抗毒蕈碱药物数量（IRR，0.991；95% CI，0.985 - 0.997；P = 0.006）和药物总数（IRR，0.988；95% CI，0.983 - 0.994；P < 0.001）均减少。多变量泊松回归显示，年龄增加和痴呆病史与ARS评分呈负相关（IRR，0.97；95% CI，0.94 - 0.99；P = 0.001和IRR，0.62；95% CI，0.41 - 0.92；P = 0.019）。相比之下，机构化（IRR，1.32；95% CI，1.00 - 1.74；P = 0.050）、Charlson合并症指数（IRR，1.06；95% CI，1.01 - 1.11；P = 0.015）和非抗毒蕈碱药物总数（IRR，1.13；95% CI，1.08 - 1.18；P < 0.001）均与ARS评分呈正相关。剂量调整后的ARS评分也观察到类似结果。
在老年住院患者中，机构化、合并症和非抗毒蕈碱多药合用与ARS及剂量调整后的ARS评分呈独立正相关。年龄增加和痴呆与ARS评分呈负相关。
