导致轻度认知障碍、痴呆和多种慢性病的老年人抗胆碱能负担及跌倒或跌倒相关损伤风险的药物：一项回顾性队列研究
Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study.
作者信息
Green Ariel R, Reifler Liza M, Bayliss Elizabeth A, Weffald Linda A, Boyd Cynthia M
机构信息
Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th Floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA.
出版信息
Drugs Aging. 2019 Mar;36(3):289-297. doi: 10.1007/s40266-018-00630-z.
BACKGROUND
It is not known whether drugs with different anticholinergic ratings contribute proportionately to overall anticholinergic score.
OBJECTIVES
Our objective was to assess the risk of falls or fall-related injuries as a function of the overall anticholinergic score resulting from drugs with different anticholinergic ratings among people with impaired cognition.
METHODS
This was a retrospective cohort study of adults aged ≥ 65 years with mild cognitive impairment (MCI) or dementia and two or more additional chronic conditions (N = 10,698) in an integrated delivery system. Electronic health record data, including pharmacy fills and diagnosis claims, were used to assess anticholinergic medication use, quantified using the anticholinergic cognitive burden (ACB) scale, falls and fall-related injuries.
RESULTS
During a median follow-up of 366 days, 63% of the cohort used one or more ACB drug; 2015 (18.8%) people experienced a fall or fall-related injury. Among patients with a daily ACB score of 5, the greatest increase in risk of falls or fall-related injuries was seen when level 2 and level 3 drugs were used in combination [hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.51-2.83]. Multiple ACB level 1 drugs taken together also increased the hazard of a fall or fall-related injury (HR 1.16; 95% CI 1.03-1.32). The risk of fall or fall-related injury as a function of exposure to ACB level 2 drugs (HR 1.56; 95% CI 1.16-2.10) was higher than that for ACB level 1 or 3 drugs.
CONCLUSIONS
The same daily ACB score was associated with a different degree of risk, depending on the ACB ratings of the individual drugs comprising the score. Combinations of level 2 and level 3 drugs had the greatest risk of fall or fall-related injury relative to other individuals with the same daily ACB score. Low-potency anticholinergic drugs taken together modestly increased the hazard of a fall or fall-related injury.
背景
具有不同抗胆碱能评分的药物对总体抗胆碱能评分的贡献是否成比例尚不清楚。
目的
我们的目的是评估认知功能受损人群中，因具有不同抗胆碱能评分的药物导致的总体抗胆碱能评分与跌倒或跌倒相关损伤风险之间的关系。
方法
这是一项对综合医疗服务系统中年龄≥65岁、患有轻度认知障碍（MCI）或痴呆且伴有两种或更多种其他慢性疾病的成年人进行的回顾性队列研究（N = 10698）。利用电子健康记录数据，包括药房配药和诊断索赔信息，来评估抗胆碱能药物的使用情况（使用抗胆碱能认知负担（ACB）量表进行量化）、跌倒及跌倒相关损伤情况。
结果
在中位随访期366天内，63%的队列使用了一种或多种ACB药物；2015人（18.8%）发生了跌倒或跌倒相关损伤。在每日ACB评分为5分的患者中，当2级和3级药物联合使用时，跌倒或跌倒相关损伤风险增加最为显著[风险比（HR）2.06；95%置信区间（CI）1.51 - 2.83]。同时服用多种1级ACB药物也会增加跌倒或跌倒相关损伤的风险（HR 1.16；95% CI 1.03 - 1.32）。与ACB 1级或3级药物相比，因接触2级ACB药物导致跌倒或跌倒相关损伤的风险更高（HR 1.56；95% CI 1.16 - 2.10）。
结论
相同的每日ACB评分与不同程度的风险相关，这取决于构成该评分的各个药物的ACB评级。相对于每日ACB评分相同的其他个体，2级和3级药物联合使用时发生跌倒或跌倒相关损伤的风险最大。同时服用低效抗胆碱能药物会适度增加跌倒或跌倒相关损伤的风险。
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