Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Drugs Aging. 2012 May 1;29(5):395-404. doi: 10.2165/11631420-000000000-00000.
Medications with anticholinergic and sedative effects carry significant risks in older people. Adverse events arising from the use of these medications may also lead to hospitalization and contribute to length of stay. The Drug Burden Index (DBI) is a tool that measures a person's total exposure to medications with anticholinergic and sedative properties, using the principles of dose response and maximal effect. Cumulative anticholinergic and sedative drug burden measured using the DBI has been associated with clinically important outcomes in older people. The association between the DBI and hospitalization still remains relatively unknown.
The main aim of this study was to evaluate the relationship between DBI and hospitalization in a population-based sample of community-dwelling older Finns over a 1-year period.
The health status and medication use of 339 community-dwelling ≥75-year-old Finns were assessed in 2004. Data on hospitalizations over the following year were obtained from the national discharge register. Two different measures were used to assess hospitalizations in the study sample: (i) the proportion of hospitalized participants; and (ii) the number of hospital days per person-year. Estimates for the number of hospital days per person-year and rate ratios (RRs) with 95% confidence intervals (CIs) were calculated using Poisson or negative binomial regression analysis.
A total of 127 participants (38%) were exposed to DBI medications; 27% had a low DBI (>0 to <1), and 11% had a high DBI (≥1). The number of hospital days per person-year was 7.9 (95% CI 7.6, 8.3) for the unexposed participants (DBI = 0) and 13.4 (95% CI 12.8, 14.1) for the exposed participants (DBI >1); the age, gender and co-morbidity adjusted RR of hospital days per person-year between the exposed and unexposed participants was 1.26 (95% CI 1.18, 1.35). Between the low and high DBI groups, the difference in the number of hospital days per person-year was insignificant (p = 0.42). In multivariate analyses, the number of regularly used medications (RR = 1.12 [95% CI 1.00, 1.26] per additional medication) and the measure of basic activities of daily living Barthel Index (RR = 0.94 [95% CI 0.88, 0.99] per increase) were independently associated with the use of hospital days.
Exposure to DBI medications was associated with a greater use of hospital days, but a cumulative dose-response relationship between DBI and hospitalization was not observed. The number of regularly used medications and functioning in the basic activities of daily living predicted hospital care utilization.
具有抗胆碱能和镇静作用的药物在老年人中存在重大风险。这些药物的使用产生的不良事件也可能导致住院，并导致住院时间延长。药物负担指数（DBI）是一种使用剂量反应和最大效应原理衡量一个人接触具有抗胆碱能和镇静特性的药物总量的工具。使用 DBI 测量的累积抗胆碱能和镇静药物负担与老年人的临床重要结局有关。DBI 与住院之间的关联仍然相对未知。
本研究的主要目的是评估 DBI 与居住在社区的 339 名芬兰≥75 岁老年人在 1 年内的住院情况之间的关系。
2004 年评估了 339 名居住在社区的≥75 岁芬兰人的健康状况和药物使用情况。在接下来的一年中，从国家出院登记处获得了有关住院的信息。在研究样本中使用了两种不同的措施来评估住院情况：（i）住院参与者的比例；（ii）每人每年的住院天数。使用泊松或负二项式回归分析计算每人每年的住院天数估计数和率比（RR）及其 95%置信区间（CI）。
共有 127 名参与者（38%）接触了 DBI 药物；27%的人 DBI 较低（>0 至<1），11%的人 DBI 较高（≥1）。未暴露参与者（DBI=0）的每人每年住院天数为 7.9（95%CI 7.6，8.3），暴露参与者（DBI>1）的每人每年住院天数为 13.4（95%CI 12.8，14.1）；暴露和未暴露参与者之间每人每年住院天数的年龄、性别和合并症调整 RR 为 1.26（95%CI 1.18，1.35）。在低 DBI 组和高 DBI 组之间，每人每年住院天数的差异无统计学意义（p=0.42）。在多变量分析中，常规使用药物的数量（每增加一种药物 RR=1.12[95%CI 1.00，1.26]）和基本日常生活活动巴氏量表（Barthel Index）（RR=0.94[95%CI 0.88，0.99]）与住院天数的使用呈独立相关。
接触 DBI 药物与更多使用住院天数有关，但 DBI 与住院之间未观察到累积剂量-反应关系。常规使用药物的数量和基本日常生活活动的功能预测了住院护理的利用。
