Pharmaceutical Unit, Charpennes Hospital, University Hospital of Lyon, Lyon, France.
University Lyon 1, Lyon, France.
Int J Clin Pharm. 2020 Apr;42(2):508-514. doi: 10.1007/s11096-020-01007-2. Epub 2020 Mar 5.
Objective To investigate the association between the medication exposure, measured by the polypharmacy/excessive polypharmacy and the anticholinergic and/or sedative drug exposure, on frailty status among French older community-dwelling patients. Setting day-care unit in France (Lyon), with retrospective data from July, 2017 to March, 2018. Method This monocentric cross-sectional study included community-dwelling patients aged 65 years and over and admitted at the day-care unit for a geriatric evaluation. Frailty was assessed according to the frailty phenotype, described by Fried et al. Polypharmacy and excessive polypharmacy were defined as the concomitant use of 5-9 and 10 or more drugs, respectively. The cumulative anticholinergic and sedative exposure was measured using the drug burden index (DBI). The DBI score was presented in 4 differentiated scores: a null score (DBI = 0), a combined score (anticholinergic and sedative score), an anticholinergic score, and a sedative score. The association between medication and frailty was assessed by logistic regression models controlled for multiple potential confounders. Main outcome measure Association between medication exposure (polypharmacy, anticholinergic and sedative exposure) and frailty. Results In this study, 403 patients were included: 44.7% were frail and 40.7% were pre-frail. Polypharmacy and excessive polypharmacy affected 44.7% and 17.1% of the population respectively. The mean DBI was 0.33 ± 0.43, with 16.4% of patients with only sedative exposure, 9.7% with only anticholinergic exposure and 33.0% with both exposures. After adjustment, polypharmacy and excessive polypharmacy were associated with frailty with adjusted odds ratios (95% confidence interval) of 2.18 (1.03-4.22) and 2.72 (1.01-7.37) respectively. The cumulative exposure to anticholinergic and sedative drugs (combined score) was significantly associated to an increased risk for frailty with adjusted odds ratios (95% confidence interval) of 3.54 (1.47-8.57). Conclusion The study showed that polypharmacy and cumulative anticholinergic and sedative exposure are associated with frailty. Further research should address the potential benefit of collaborative medication review for preventing medication-associated frailty.
目的 研究法国社区居住的老年患者中，药物暴露（通过多药治疗/过度多药治疗和抗胆碱能药/镇静剂药物暴露来衡量）与虚弱状态之间的关系。
设置 法国里昂的日间护理病房，使用 2017 年 7 月至 2018 年 3 月的回顾性数据。
方法 本单中心横断面研究纳入了年龄在 65 岁及以上并在日间护理病房接受老年评估的社区居住患者。虚弱状态根据 Fried 等人描述的虚弱表型进行评估。多药治疗和过度多药治疗分别定义为同时使用 5-9 种和 10 种或更多种药物。使用药物负担指数（DBI）测量累积抗胆碱能药和镇静剂暴露。DBI 评分分为 4 个不同的分数：零分（DBI=0）、综合评分（抗胆碱能药和镇静剂评分）、抗胆碱能药评分和镇静剂评分。通过多变量潜在混杂因素调整的逻辑回归模型评估药物与虚弱之间的关联。
主要结局测量 药物暴露（多药治疗、抗胆碱能药和镇静剂暴露）与虚弱之间的关系。
结果 在这项研究中，纳入了 403 名患者：44.7%为虚弱，40.7%为虚弱前期。多药治疗和过度多药治疗分别影响了 44.7%和 17.1%的人群。平均 DBI 为 0.33±0.43，16.4%的患者仅存在镇静剂暴露，9.7%的患者仅存在抗胆碱能药暴露，33.0%的患者同时存在两种暴露。调整后，多药治疗和过度多药治疗与虚弱相关，调整后的优势比（95%置信区间）分别为 2.18（1.03-4.22）和 2.72（1.01-7.37）。累积抗胆碱能药和镇静剂药物暴露（综合评分）与虚弱的风险增加显著相关，调整后的优势比（95%置信区间）为 3.54（1.47-8.57）。
结论 该研究表明，多药治疗和累积抗胆碱能药和镇静剂暴露与虚弱有关。进一步的研究应该探讨协作药物审查在预防与药物相关的虚弱方面的潜在益处。
