Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Ann Med. 2012 Aug;44(5):458-67. doi: 10.3109/07853890.2011.573499. Epub 2011 Apr 15.
This cross-sectional study aimed to investigate the relationship between exposure to anticholinergic and sedative medications, measured with the Drug Burden Index (DBI), and functional outcomes in community-dwelling older people living in Finland.
The study population consisted of community-dwelling older people (n = 700) enrolled in the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study. Outcomes included walking speed, chair stands test, grip strength, timed up and go (TUG) test, instrumental activities of daily living (IADL), and Barthel Index.
Exposure to DBI drugs was identified in 37% of participants: 24% had a DBI range between >0 <1, and 13% DBI ≥ 1. After adjusting for confounders, exposure to DBI drugs was associated with slower walking speed (P < 0.0001), poorer performance on chair stands (P = 0.0001) and TUG (P < 0.0001), difficulties in IADL (P < 0.0001), and Barthel Index (P < 0.0001). The mean adjusted walking speed, time to complete chair stands and TUG, IADL, and Barthel scores were significantly poorer among participants with higher DBI ranges.
In older adults living in Finland, DBI was associated with impaired function on previously tested and new outcomes. This finding supports the use of the DBI as tool, in combination with other assessments, to identify older people at risk of functional impairment. The findings highlight the need for revision of current guidelines to improve the quality of drug use in older people.
本横断面研究旨在探讨暴露于抗胆碱能和镇静药物（用药物负担指数（DBI）衡量）与居住在芬兰的社区老年人的功能结局之间的关系。
研究人群包括参加老年多学科综合策略以关爱老年人（GeMS）研究的社区居住的老年人（n=700）。结局包括行走速度、椅子站立测试、握力、计时起立行走（TUG）测试、工具性日常生活活动（IADL）和巴氏指数。
37%的参与者存在 DBI 药物暴露：24%的 DBI 范围为>0<1，13%的 DBI ≥ 1。在调整混杂因素后，DBI 药物暴露与行走速度较慢（P<0.0001）、椅子站立（P=0.0001）和 TUG （P<0.0001）表现较差、IADL （P<0.0001）和巴氏指数（P<0.0001）困难有关。DBI 范围较高的参与者的平均调整行走速度、完成椅子站立和 TUG 的时间、IADL 和巴氏评分明显较差。
在居住在芬兰的老年人中，DBI 与先前测试和新结局的功能障碍有关。这一发现支持将 DBI 与其他评估结合使用，作为识别有功能障碍风险的老年人的工具。这一发现强调需要修订当前指南，以提高老年人药物使用的质量。
