Kachru Nandita, Carnahan Ryan M, Johnson Michael L, Aparasu Rajender R
Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX.
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
J Am Pharm Assoc (2003). 2015 Nov-Dec;55(6):603-612. doi: 10.1331/JAPhA.2015.14288.
To examine the prevalence and predictors of potentially inappropriate anticholinergic medication use in older adults with dementia.
A cross-sectional study.
United States, 2009-2010.
Medical Expenditure Panel Survey household component participants aged 65 years or older identified as having dementia and using potentially inappropriate anticholinergic medication.
Prevalence and predictors of potentially inappropriate anticholinergic medication use as per the updated 2012 American Geriatrics Society Beers criteria.
A total of 3.78 million older adult patients (95% confidence interval [CI] 3.17 million to 4.38 million) were identified as having dementia, for an overall prevalence of 4.81%. Of those patients, an estimated 1.02 million (95% CI 0.70 million to 1.30 million) were reported to use potentially inappropriate anticholinergic medications, for an overall prevalence of 26.95% (95% CI 20.10% to 33.79%). The most frequently prescribed drugs were oxybutynin, solifenacin, paroxetine, tolterodine, promethazine, and cyclobenzaprine. Multivariable logistic analysis revealed that those patients with the need characteristics of self-reported anxiety, mood disorders, and "fair/poor" general health status had increased odds of potentially inappropriate anticholinergic use, while patients with the predisposing characteristic of being aged 75-84 years had decreased odds of potentially inappropriate anticholinergic use.
More than one in four older adults with dementia were found to use potentially inappropriate anticholinergics. Given the adverse cognitive effects of these medications, there is a strong need to monitor and optimize their use in older adult patients with dementia.
研究老年痴呆患者中潜在不适当使用抗胆碱能药物的患病率及预测因素。
横断面研究。
美国，2009 - 2010年。
医疗支出面板调查家庭部分中年龄在65岁及以上、被确定患有痴呆且使用潜在不适当抗胆碱能药物的参与者。
根据2012年更新的美国老年医学会Beers标准，潜在不适当使用抗胆碱能药物的患病率及预测因素。
总共识别出378万老年患者（95%置信区间[CI]为317万至438万）患有痴呆，总体患病率为4.81%。在这些患者中，估计有102万（95% CI为70万至130万）报告使用了潜在不适当的抗胆碱能药物，总体患病率为26.95%（95% CI为20.10%至33.79%）。最常开具的药物是奥昔布宁、索利那新、帕罗西汀、托特罗定、异丙嗪和环苯扎林。多变量逻辑分析显示，那些自我报告有焦虑、情绪障碍以及“一般健康状况为‘中等/差’”等需求特征的患者，潜在不适当使用抗胆碱能药物的几率增加，而年龄在75 - 84岁这一易患特征的患者，潜在不适当使用抗胆碱能药物的几率降低。
发现超过四分之一的老年痴呆患者使用了潜在不适当的抗胆碱能药物。鉴于这些药物对认知的不良影响，非常有必要监测并优化老年痴呆患者对其的使用。
