Khezrian Mina, McNeil Christopher J, Myint Phyo K, Murray Alison D
Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
Ageing Clinical and Experimental Research, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
Int J Clin Pharm. 2019 Feb;41(1):251-257. doi: 10.1007/s11096-018-0761-2. Epub 2018 Nov 29.
Background Polypharmacy is a growing health concern for older adults and is associated with poorer clinical outcome. Objective This study aim is to investigate the association between polypharmacy and impairment in cognitive, physical and emotional capability controlling for the confounding effect of co-morbidities. Setting The Aberdeen 1936 Birth Cohort from 1999 to 2004. Method Recruited were 498 dementia free participants around 64 years old and recruited into wave one. Linear regression and structural equation models were used. Models were adjusted for the effect of age, gender, childhood IQ, education and Body Mass Index. A triad of impairment was defined as a composite measure of impairment in cognitive, physical and emotional function. Main outcome measure The relationships between polypharmacy, co-morbidity and triad of impairment. Results The prevalence of polypharmacy was 12.3% in this relatively healthy sample. Polypharmacy was significantly associated with increased impairment in cognitive, physical and emotional ability (β = 3.6, p = 0.003) after controlling for the effect of comorbidities and other confounding variables. As expected, higher childhood IQ and educational achievement had protective effects against impairment while higher comorbidity score and Body Mass Index were associated with increased impairment in this population. Conclusions The independent association of polypharmacy and reduced cognitive, physical and emotional capability makes this a promising target for predicting and potentially reducing the risk of impairment and associated healthcare costs in older adults. Longitudinal studies are required to investigate the underlying mechanisms for the observed relationships further.
背景 多重用药对老年人来说是一个日益严重的健康问题，且与较差的临床结果相关。目的 本研究旨在调查多重用药与认知、身体和情感能力受损之间的关联，同时控制合并症的混杂效应。研究地点 1999年至2004年的阿伯丁1936年出生队列。方法 招募了498名年龄约64岁、无痴呆症的参与者进入第一波研究。使用了线性回归和结构方程模型。模型针对年龄、性别、童年智商、教育程度和体重指数的影响进行了调整。三联症损伤被定义为认知、身体和情感功能损伤的综合指标。主要结局指标 多重用药、合并症与三联症损伤之间的关系。结果 在这个相对健康的样本中，多重用药的患病率为12.3%。在控制合并症和其他混杂变量的影响后，多重用药与认知、身体和情感能力的损伤增加显著相关（β = 3.6，p = 0.003）。正如预期的那样，较高的童年智商和教育成就对损伤有保护作用，而较高的合并症得分和体重指数与该人群中损伤的增加相关。结论 多重用药与认知、身体和情感能力下降之间的独立关联，使得这成为预测并可能降低老年人损伤风险及相关医疗成本的一个有前景的目标。需要进行纵向研究以进一步探究所观察到的关系的潜在机制。
