Dauphinot V, Faure R, Bourguignon L, Goutelle S, Krolak-Salmon P, Mouchoux C
Centre Mémoire de Ressources et de Recherche (CMRR) de Lyon, Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne.
Centre de Recherche Clinique-Vieillissement-Cerveau-Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne.
Eur J Neurol. 2017 Mar;24(3):483-490. doi: 10.1111/ene.13228. Epub 2016 Dec 27.
Elderly patients exposed to drugs with anticholinergic or sedative properties may have an increased risk of adverse events. This study aimed to assess the relationship between patient characteristics and changes of exposure to anticholinergic and sedative medications during their hospital stay.
A multicentre longitudinal study was set up on hospitalized patients (aged ≥65 years) using at least one drug at admission. The primary outcome was change of exposure to anticholinergic and sedative drugs between admission and discharge. Sociodemographic characteristics of the patients, comorbidities, life habits and information about the hospital stay (origin of admission, reasons for hospitalization) were collected.
The study included 337 patients (mean age, 85.4 years) with an average hospital stay of 30.1 ± 37.5 days. The drug burden index increased during the hospital stay among males (P = 0.03), patients for whom the reason for hospitalization was either a stroke (P = 0.001) or inability to stay in their own home (P = 0.001), and patients with diabetes mellitus (P = 0.009). In the adjusted model, drug burden index increased among patients hospitalized for stroke, inability to stay in their own home or post-surgery, and for patients with diabetes mellitus or hypertension.
The drug management of elderly patients during hospital stays may increase exposure to anticholinergic and sedative drugs. Although the anticholinergic and sedative properties may be in relation to the therapeutic purpose, they also represent an unexpected risk. Physicians and clinical pharmacists should consider performing optimization of the drug prescriptions for patients at risk.
老年患者使用具有抗胆碱能或镇静作用的药物时，不良事件风险可能增加。本研究旨在评估患者特征与住院期间抗胆碱能和镇静药物暴露变化之间的关系。
对入院时至少使用一种药物的住院患者（年龄≥65岁）开展一项多中心纵向研究。主要结局是入院与出院之间抗胆碱能和镇静药物暴露的变化。收集患者的社会人口学特征、合并症、生活习惯以及住院信息（入院来源、住院原因）。
该研究纳入了337例患者（平均年龄85.4岁），平均住院时间为30.1±37.5天。男性患者（P = 0.03）、因中风（P = 0.001）或无法居家（P = 0.001）住院的患者以及糖尿病患者（P = 0.009）在住院期间的药物负担指数增加。在调整模型中，因中风、无法居家或手术后住院的患者以及糖尿病或高血压患者的药物负担指数增加。
老年患者住院期间的药物管理可能会增加抗胆碱能和镇静药物的暴露。尽管抗胆碱能和镇静作用可能与治疗目的相关，但它们也代表了一种意外风险。医生和临床药师应考虑对有风险的患者优化药物处方。
