Pharmacy Department, Vic University Hospital - Vic Hospital Consortium; Hospital of Santa Creu of Vic (Barcelona), Spain.
Acute Geriatric Unit, Vic University Hospital, Hospital of Santa Creu of Vic (Barcelona), Spain.
Geriatr Gerontol Int. 2018 Aug;18(8):1159-1165. doi: 10.1111/ggi.13330. Epub 2018 Apr 11.
To evaluate the anticholinergic burden (ACB), the risk factors associated with its onset and the clinical consequences for patients with advanced chronic conditions.
A 10-month cross-sectional study was carried out in an acute hospital care geriatric unit. Patients with advanced chronic conditions were identified by the NECessity of PALliative care (NECPAL) test. The ACB was established using the Anticholinergic Drug Scale and Drug Burden Index (DBI) tools. Demographic, pharmacological and clinical patient data were collected with the objective of determining risk factors related to ACB. Measured clinical outcomes were the presence of acute confusional state, bone fractures, length of stay, mortality and 12-month survival rate.
A total of 235 patients were recruited (mean age 86.80 years, SD 5.37 years; 65.50% women), and 82.10% (DBI) and 93.6% (Anticholinergic Drug Scale) of the patients were treated with anticholinergic medications. Excessive polypharmacy (≥10 drugs) was identified as a risk factor for the presence of anticholinergic medication (Anticholinergic Drug Scale: OR 6.26, 95% CI 1.38-28.42; DBI: OR 3.44, 95% CI 1.60-7.38). High anticholinergic burden (by DBI >2 points) was an independent risk factor for the presence of acute confusional state on hospital admission (OR 2.98, 95% CI 1.04-8.50). However, ACB was not related to bone fractures on admission, length of stay, mortality or survival.
Patients with advanced chronic conditions are frequently treated with anticholinergic drugs, with excessive polypharmacy as a risk factor. Anticholinergic drugs are a risk factor for the presence of acute confusional state on hospital admission, but have no other effect in terms of morbimortality. Geriatr Gerontol Int 2018; 18: 1159-1165.
评估患有晚期慢性疾病患者的抗胆碱能负担（ACB）、与其发病相关的危险因素以及对患者的临床后果。
在急性医院老年病护理病房进行了一项为期 10 个月的横断面研究。通过 NECessity of PALliative care（NECPAL）测试确定患有晚期慢性疾病的患者。使用抗胆碱能药物量表和药物负担指数（DBI）工具确定 ACB。收集人口统计学、药理学和临床患者数据，目的是确定与 ACB 相关的危险因素。测量的临床结果是急性意识混乱状态、骨折、住院时间、死亡率和 12 个月生存率的存在。
共纳入 235 例患者（平均年龄 86.80 岁，标准差 5.37 岁；65.50%为女性），82.10%（DBI）和 93.6%（抗胆碱能药物量表）的患者接受了抗胆碱能药物治疗。过度多种药物治疗（≥10 种药物）被确定为使用抗胆碱能药物的危险因素（抗胆碱能药物量表：比值比 6.26，95%置信区间 1.38-28.42；DBI：比值比 3.44，95%置信区间 1.60-7.38）。高抗胆碱能负担（按 DBI >2 分）是入院时急性意识混乱状态的独立危险因素（比值比 2.98，95%置信区间 1.04-8.50）。然而，ACB 与入院时的骨折、住院时间、死亡率或生存率无关。
患有晚期慢性疾病的患者经常接受抗胆碱能药物治疗，过度多种药物治疗是一个危险因素。抗胆碱能药物是入院时急性意识混乱状态的危险因素，但在发病率和死亡率方面没有其他影响。老年医学与老年病学国际 2018；18：1159-1165。
