Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
Intern Med J. 2013 Aug;43(8):912-8. doi: 10.1111/imj.12203.
To investigate the changes in polypharmacy and the drug burden index (DBI) occurring during hospitalisation for older people. The secondary aim was to examine the associations of these two measures with the length of hospital stay and admission for falls or delirium.
A retrospective analysis of patients' medical records was undertaken at a large university teaching hospital (Sydney, Australia) for patients with the age of ≥ 65 years and admitted under the care of the geriatric medicine or rehabilitation teams. Polypharmacy was defined as the use of more than five regular medications. The DBI measures exposure to drugs with anticholinergic and sedative effects. Logistic regression analysis was conducted to investigate the associations between polypharmacy and DBI with outcome measures. Data are presented using odds ratios with 95% confidence intervals.
A total of 329 patients was included in this study. The mean (± standard deviation) age of the population was 84.6 ± 7.0 years, 62% were female and 40% were admitted from residential aged-care facilities. On admission, polypharmacy was observed in 60% of the cohort and DBI exposure for 50%. DBI and polypharmacy exposure decreased during hospitalisation, but only the number of medications taken decreased by a statistically significant margin (P = 0.02). Patients with a high DBI (≥ 1) were approximately three times more likely to be admitted for delirium than those with no DBI exposure (odds ratio, 2.95; 95% confidence interval, 1.34-6.51).
In the present study, DBI was associated with an increased risk of hospital admission for delirium only. Polypharmacy was not associated with any of the clinical measures.
调查老年人住院期间发生的多种药物治疗和药物负担指数（DBI）的变化。次要目的是研究这两个指标与住院时间和因跌倒或谵妄入院的关系。
在澳大利亚悉尼的一家大型大学教学医院，对年龄≥65 岁且由老年医学或康复团队护理的患者的病历进行回顾性分析。多种药物治疗定义为使用超过五种常规药物。DBI 衡量的是暴露于具有抗胆碱能和镇静作用的药物。采用逻辑回归分析来研究多种药物治疗和 DBI 与结局指标之间的关系。数据以比值比及其 95%置信区间表示。
本研究共纳入 329 例患者。人群的平均（±标准差）年龄为 84.6±7.0 岁，62%为女性，40%为从养老院入院。入院时，60%的患者存在多种药物治疗，50%的患者存在 DBI 暴露。DBI 和多种药物治疗的暴露在住院期间下降，但只有服用的药物数量显著减少（P=0.02）。DBI 较高（≥1）的患者发生谵妄的入院风险是无 DBI 暴露患者的近三倍（比值比，2.95；95%置信区间，1.34-6.51）。
在本研究中，仅 DBI 与谵妄入院风险增加有关。多种药物治疗与任何临床指标均无关。
