College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Gyeonggi-do, Republic of Korea.
College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.
Arch Gerontol Geriatr. 2019 Nov-Dec;85:103912. doi: 10.1016/j.archger.2019.103912. Epub 2019 Jul 10.
This study aimed to evaluate the impact of high anticholinergic burden on overall emergency department (ED) visits and ED visits related to adverse effects of anticholinergic drugs among older adults.
For this retrospective cohort study, we used claims data from older adults with high representativeness. The average daily Anticholinergic Risk Scale (ARS) score was calculated based on the dosage, treatment duration, and potency of anticholinergic drugs during three months. A high-exposure group (ARS ≥ 2) and a non-exposure group were included in this analysis. The primary outcome was the first ED visit during the follow-up period. Anticholinergic ED visits were defined as ED visits with a main diagnosis of a fall, fracture, dizziness, delirium, constipation, or urinary retention.
In total, 118,750 subjects (43.6% male) were included in this study. The mean age was 75.4 ± 6.6 years. The adjusted hazard ratios (aHRs) for all-cause and anticholinergic ED visits among those with high ARS scores were 1.28 (95% CI: 1.20-1.36) and 1.55 (95% CI: 1.38-1.74), respectively. The high-exposure group was at higher risk than the non-exposure group for ED visits for falls or fractures (aHR: 1.31, 95% CI: 1.07-1.60), dizziness (aHR: 1.71, 95% CI: 1.36-2.14), delirium (aHR: 2.05, 95% CI: 1.13-3.73), constipation (aHR: 1.65, 95% CI: 1.35-2.02) and urinary retention (aHR: 1.66, 95% CI: 1.30-2.12).
This study demonstrated that a high anticholinergic burden in older adults increased the risk of all-cause ED visits, anticholinergic ED visits and specific-cause ED visits.
本研究旨在评估高抗胆碱能负担对老年人整体急诊就诊和抗胆碱能药物不良反应相关急诊就诊的影响。
本回顾性队列研究使用具有高代表性的老年人的索赔数据。根据三个月内抗胆碱能药物的剂量、治疗持续时间和效力，计算平均每日抗胆碱能风险量表（ARS）评分。在此分析中纳入了高暴露组（ARS≥2）和非暴露组。主要结局为随访期间的首次急诊就诊。抗胆碱能急诊就诊定义为以跌倒、骨折、头晕、谵妄、便秘或尿潴留为主要诊断的急诊就诊。
共纳入 118750 名受试者（43.6%为男性）。平均年龄为 75.4±6.6 岁。高 ARS 评分者的全因和抗胆碱能急诊就诊的校正后风险比（aHR）分别为 1.28（95%CI：1.20-1.36）和 1.55（95%CI：1.38-1.74）。高暴露组发生跌倒或骨折（aHR：1.31，95%CI：1.07-1.60）、头晕（aHR：1.71，95%CI：1.36-2.14）、谵妄（aHR：2.05，95%CI：1.13-3.73）、便秘（aHR：1.65，95%CI：1.35-2.02）和尿潴留（aHR：1.66，95%CI：1.30-2.12）的急诊就诊风险均高于非暴露组。
本研究表明，老年人的高抗胆碱能负担增加了全因急诊就诊、抗胆碱能药物相关急诊就诊和特定病因急诊就诊的风险。
