School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales 2650, Australia.
Int Psychogeriatr. 2013 Sep;25(9):1425-31. doi: 10.1017/S1041610213000872. Epub 2013 Jun 20.
Review of recent journal articles and various relevant current textbooks provides strong evidence to show that anticholinergic burden is a material issue in frail and at-risk patients. This study assesses the anticholinergic burden in a group of patients in residential care facilities and then applies a theoretical intervention model. It is based on a scoring system known as the Anticholinergic Cognitive Burden (ACB) scale, and attempts to reduce the anticholinergic burden while maintaining therapeutic benefits.
A database of 691 patients was analyzed for each individual's ACB based on the scale of scoring produced by groups of experts in the area. A theoretical intervention was then conducted using relevant, evidence-based practice guidelines for clinical therapeutics in Australia. The intervention had the aim of reducing the total ACB without affecting the apparent intended effectiveness of the prescribed therapy.
Of the 35% (n = 242) patients who score at least 1 point on the ACB, a reduction is achievable in 59% of the cases. In particular, the reduction from a clinically significant score of 3 or above to 2 or below for 49 of those patients is possible in 85% of the cases. Overall, this represents a reduction from 7.10% to 1.01% for the entire population. It is also found that of the 246,960 counts of items dispensed (both prescription and non-prescription) for these patients, 47,334 (or 19.2%) of these were of agents on the ACB scale.
The study found that it appears to be possible that the total ACB of a group of 691 patients can be significantly reduced.
对近期期刊文章和各种相关现行教科书的回顾为体弱和高危患者的抗胆碱能负担是一个实质性问题提供了强有力的证据。本研究评估了一组居住在护理设施中的患者的抗胆碱能负担，然后应用了一种理论干预模型。它基于一个称为抗胆碱能认知负担 (ACB) 量表的评分系统，并试图在保持治疗效果的同时降低抗胆碱能负担。
根据该领域专家组制定的评分量表，对 691 名患者的数据库进行了个体的 ACB 分析。然后，使用澳大利亚临床治疗的相关循证实践指南进行了理论干预。干预的目的是在不影响规定治疗的明显预期疗效的情况下降低总 ACB。
在 ACB 得分为 1 分以上的 35%（n = 242）患者中，有 59%的患者可以降低。特别是，在 49 名患者中，将临床显著评分从 3 分或以上降低到 2 分或以下的可能性为 85%。总体而言，这代表整个人群从 7.10%降至 1.01%。研究还发现，对于这些患者的 246,960 项配药（包括处方药和非处方药），其中 47,334 项（或 19.2%）属于 ACB 量表上的药物。
研究发现，似乎有可能显著降低一组 691 名患者的总 ACB。
