Jean-Bart Elodie, Moutet Claire, Dauphinot Virginie, Krolak-Salmon Pierre, Mouchoux Christelle
Pharmacy, Charpennes Hospital Center, Hospices Civils de Lyon, 27, rue Gabriel-Péri, 69100, Villeurbanne, France.
Clinical Research Centre (CRC) - VCF (Aging - Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, Villeurbanne, France.
Int J Clin Pharm. 2017 Dec;39(6):1237-1247. doi: 10.1007/s11096-017-0533-4. Epub 2017 Oct 31.
Background There are several assessment scales to evaluate the risk of falls or the adverse drug reaction risk. Few are sufficiently specific to assess the impact of drug prescriptions on falls in geriatric populations. Objective To define the risk of anticholinergic and sedation-related ADRs in an elderly hospitalized patient population using the Drug Burden Index (DBI), Anticholinergic Drug Scale (ADS), and Sedative Load Model (SLM). Setting Five geriatric university hospital centers in France. Method Multicenter prospective cohort study from 2011 to 2013. Drug prescriptions were compiled to estimate anticholinergic and sedative exposure. Any associations between the drug scales and falls were assessed. Main outcome measure Drug exposure estimated with the DBI, ADS, and SLM scales. Results 315 patients, with a mean age of 87 years and 117 documented falls, were included from 5 geriatric hospitals. Sixty-one percent of these patients had a DBI > 0, 20.3% had an ADS ≥ 3, 56.2% a SLM > 0. No association was detected between the scores and the risk of a fall (p > 0.05). Factors significantly associated with a risk of a fall were: a prior history of a fall in the previous 12 months (adjusted odds ratio [aOR] = 7.24, 4.06-12.89), orthostatic hypotension ([aOR] = 2.84; 1.39-5.79), or prescription of antidepressants ([aOR] = 2.12; 1.17-3.84). Conclusion A specific scale to identify high-risk prescriptions would help clinicians and pharmacists to optimize therapeutic treatments for the elderly. In light of the multifactorial characteristics of falls, predicting their risk should be based on a well-defined set of factors.
有几种评估量表可用于评估跌倒风险或药物不良反应风险。但很少有量表能足够具体地评估药物处方对老年人群跌倒的影响。目的：使用药物负担指数（DBI）、抗胆碱能药物量表（ADS）和镇静负荷模型（SLM）来确定老年住院患者中抗胆碱能和镇静相关药物不良反应的风险。地点：法国的五个老年大学医院中心。方法：2011年至2013年的多中心前瞻性队列研究。汇总药物处方以估计抗胆碱能和镇静药物暴露情况。评估药物量表与跌倒之间的任何关联。主要结局指标：用DBI、ADS和SLM量表估计的药物暴露情况。结果：来自5家老年医院的315例患者被纳入研究，平均年龄87岁，有117例跌倒记录。这些患者中61%的DBI>0，20.3%的ADS≥3，56.2%的SLM>0。未发现评分与跌倒风险之间存在关联（p>0.05）。与跌倒风险显著相关的因素有：过去12个月内有跌倒史（调整后的优势比[aOR]=7.24，4.06 - 12.89）、体位性低血压（[aOR]=2.84；1.39 - 5.79）或抗抑郁药处方（[aOR]=2.12；1.17 - 3.84）。结论：一种用于识别高风险处方的特定量表将有助于临床医生和药剂师优化老年人的治疗方案。鉴于跌倒的多因素特征，预测其风险应基于一组明确的因素。
