Unit of Geriatric Pharmacoepidemiology and Biostatistics, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy.
Unit of Geriatric Medicine, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy.
Drugs Aging. 2020 Jun;37(6):447-455. doi: 10.1007/s40266-020-00766-x.
The relationship between anticholinergic burden and mortality is unclear, and the impact of anticholinergic burden on prognosis may vary in the presence of other conditions common in old age. We aimed to investigate the role of hand grip strength as a potential effect modifier in the association between anticholinergic burden and 1-year mortality in older patients discharged from hospital.
Our series consisted of 620 older patients consecutively admitted to seven geriatric and internal medicine acute care wards in the context of a prospective multicenter observational study. Overall anticholinergic burden was assessed by Anticholinergic Cognitive Burden (ACB) score. Hand grip strength was assessed by the use of a North Coast medical hand dynamometer and categorized by using sex-specific cut-offs (women < 15 kg, men < 20 kg). The study outcome was 1-year mortality. Statistical analysis was performed by Cox regression analysis.
After adjusting for potential confounders, the co-occurrence of an ACB score of 2 or more and low hand grip strength was significantly associated with mortality (hazard ratio [HR] = 2.30, 95% confidence interval [CI] 1.07-6.01). Stratified analysis confirmed that an ACB score of 2 or more was associated with mortality among patients with low (HR = 2.15, 95% CI 1.08-5.02), but not normal hand grip strength (HR = 0.88, 95% CI 0.13-3.52). The association was confirmed among patients with low hand grip strength after adjusting for the ACB score at the 3-month follow-up (HR = 2.20; 95% CI 1.09-4.87), as well as when considering the ACB score as a continuous variable (HR = 1.24, 95% CI 1.03-1.48).
The ACB score at discharge may predict mortality among older patients discharged from an acute care hospital with low hand grip strength. Hospital physicians should be aware that prescribing anticholinergic medications in such a vulnerable population may have negative prognostic implications.
抗胆碱能负担与死亡率之间的关系尚不清楚，并且在老年人常见的其他情况下，抗胆碱能负担对预后的影响可能有所不同。我们旨在研究握力作为潜在的效应修饰因子在出院老年患者的抗胆碱能负担与 1 年死亡率之间的相关性中的作用。
我们的系列包括 620 名连续入住 7 个老年科和内科急症病房的老年患者，这是一项前瞻性多中心观察性研究的一部分。总体抗胆碱能负担通过抗胆碱能认知负担 (ACB) 评分来评估。握力使用 North Coast 医疗手握力计进行评估，并使用性别特异性截断值进行分类（女性<15kg，男性<20kg）。研究结果是 1 年死亡率。通过 Cox 回归分析进行统计分析。
在调整了潜在的混杂因素后，ACB 评分≥2 分和握力低的同时存在与死亡率显著相关（风险比 [HR] = 2.30，95%置信区间 [CI] 1.07-6.01）。分层分析证实，ACB 评分≥2 分与握力低的患者的死亡率相关（HR = 2.15，95%CI 1.08-5.02），但与正常握力强度无关（HR = 0.88，95%CI 0.13-3.52）。在调整 3 个月随访时的 ACB 评分后（HR = 2.20；95%CI 1.09-4.87），以及在考虑 ACB 评分作为连续变量时（HR = 1.24，95%CI 1.03-1.48），均确认了低握力强度患者中的这种关联。
出院时的 ACB 评分可能预测急性护理医院出院的低握力老年患者的死亡率。医院医生应该意识到，在这样一个脆弱的人群中开具抗胆碱能药物可能会产生负面的预后影响。
