Jamsen Kris M, Bell J Simon, Hilmer Sarah N, Kirkpatrick Carl M J, Ilomäki Jenni, Le Couteur David, Blyth Fiona M, Handelsman David J, Waite Louise, Naganathan Vasi, Cumming Robert G, Gnjidic Danijela
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
J Am Geriatr Soc. 2016 Jan;64(1):89-95. doi: 10.1111/jgs.13877.
To investigate the effects of number of medications and Drug Burden Index (DBI) on transitions between frailty stages and death in community-dwelling older men.
Cohort study.
Sydney, Australia.
Community-dwelling men aged 70 and older (N=1,705).
Self-reported questionnaires and clinic visits were conducted at baseline and 2 and 5 years. Frailty was assessed at all three waves according to the modified Fried frailty phenotype. The total number of regular prescription medications and DBI (a measure of exposure to sedative and anticholinergic medications) were calculated over the three waves. Data on mortality over 9 years were obtained. Multistate modeling was used to characterize the transitions across three frailty states (robust, prefrail, frail) and death.
Each additional medication was associated with a 22% greater risk of transitioning from the robust state to death (adjusted 95% confidence interval (CI)=1.06-1.41). Every unit increase in DBI was associated with a 73% greater risk of transitioning from the robust state to the prefrail state (adjusted 95% CI=1.30-2.31) and a 2.75 times greater risk of transitioning from the robust state to death (adjusted 95% CI=1.60-4.75). There was no evidence of an adjusted association between total number of medications or DBI and the other transitions.
Although the possibility of confounding by indication cannot be excluded, additional medications were associated with greater risk of mortality in robust community-dwelling older men. Greater DBI was also associated with greater risk of death and transitioning from the robust state to the prefrail state.
研究药物数量和药物负担指数（DBI）对社区居住老年男性虚弱阶段转变和死亡的影响。
队列研究。
澳大利亚悉尼。
70岁及以上的社区居住男性（N = 1705）。
在基线、2年和5年时进行自我报告问卷调查和门诊就诊。根据改良的弗里德虚弱表型在所有三个时间点评估虚弱情况。计算三个时间点的常规处方药总数和DBI（一种衡量镇静和抗胆碱能药物暴露的指标）。获取9年期间的死亡率数据。使用多状态模型来描述三个虚弱状态（强健、虚弱前期、虚弱）和死亡之间的转变。
每增加一种药物，从强健状态转变为死亡的风险增加22%（调整后的95%置信区间（CI）= 1.06 - 1.41）。DBI每增加一个单位，从强健状态转变为虚弱前期状态的风险增加73%（调整后的95% CI = 1.30 - 2.31），从强健状态转变为死亡的风险增加2.75倍（调整后的95% CI = 1.60 - 4.75）。没有证据表明药物总数或DBI与其他转变之间存在经调整的关联。
尽管不能排除指示性混杂的可能性，但在强健的社区居住老年男性中，额外的药物与更高的死亡风险相关。更高的DBI也与更高的死亡风险以及从强健状态转变为虚弱前期状态相关。
