University of East Anglia, Norwich, UK.
University of East Anglia, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK.
BMC Geriatr. 2020 Jul 31;20(1):267. doi: 10.1186/s12877-020-01657-x.
Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England's older population in 1991 and 2011, and describe changes in use by participant's age, sex, cognition and disability.
We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N = 7635) and 2008-2011 (N = 7762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score = 3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability.
Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95% CI 1.67-2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergics in CFAS II (16.5% [95% CI 12.0-22.3%]). Large increases in the prevalence of the use medication with 'any' anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II).
Use of potent anticholinergic medications nearly doubled in England's older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.
抗胆碱能药物的使用与认知能力下降、痴呆、跌倒和死亡风险增加有关，因此应限制老年人使用此类药物。在此，我们评估了 1991 年和 2011 年英格兰老年人群中抗胆碱能药物的使用情况，并描述了参与者年龄、性别、认知能力和残疾程度对药物使用的影响。
我们比较了 1990-1993 年（n=7635）和 2008-2011 年（n=7762）参加认知功能和衰老研究（CFAS I 和 II）的 65 岁及以上人群的数据。我们使用逆概率加权法对数据进行标准化，以匹配 2011 年英国人口，并估计了强效抗胆碱能药物的使用情况（抗胆碱能认知负担[ACB]评分=3）和平均抗胆碱能负担（ACB 评分总和）。这些数据按照年龄、性别、简易精神状态检查评分以及日常生活活动（ADL）或工具性日常生活活动（IADL）残疾进行分层。
1990-1993 年，强效抗胆碱能药物的使用比例从老年人群的 5.7%（95%置信区间 5.2-6.3%）增加到 2008-2011 年的 9.9%（9.3-10.7%），调整后的优势比为 1.90（95%置信区间 1.67-2.16）。在 CFAS II 中，有明显认知障碍（MMSE[简易精神状态检查]评分 21 或以下）的患者是强效抗胆碱能药物的主要使用者（16.5%[95%置信区间 12.0-22.3%]）。在有明显认知障碍的老年人中，具有“任何”抗胆碱能活性的药物的使用比例也显著增加（CFAS I 中为 53.3%，CFAS II 中为 71.5%）。
在 20 多年的时间里，英格兰老年人群中强效抗胆碱能药物的使用几乎翻了一番，而在那些特别容易受到抗胆碱能药物副作用影响的人群中，这一比例的增幅最大。
