St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2020 Nov;68(11):2516-2524. doi: 10.1111/jgs.16710. Epub 2020 Aug 15.
BACKGROUND/OBJECTIVES: To examine the association between hospitalization for a fall-related injury and the co-prescription of a cholinesterase inhibitor (ChEI) among persons with dementia receiving a beta-blocker, and whether this potential drug-drug interaction is modified by frailty.
Nested case-control study using population-based administrative databases.
All nursing homes in Ontario, Canada.
Persons with dementia aged 66 and older who received at least one beta-blocker between April 2013 and March 2018 following nursing home admission (n = 19,060).
Cases were persons with dementia with a hospitalization (emergency department visit or acute care admission) for a fall-related injury with concurrent beta-blocker use. Each case (n = 3,038) was matched 1:1 to a control by age (±1 year), sex, cohort entry year, frailty, and history of fall-related injuries. The association between fall-related injury and exposure to a ChEI in the 90 days prior was examined using multivariable conditional logistic regression. Secondary exposures included ChEI type, daily dose, incident versus prevalent use, and use in the prior 30 days. Subgroup analyses considered frailty, age group, sex, and history of hospitalization for fall-related injuries.
Exposure to a ChEI in the prior 90 days occurred among 947 (31.2%) cases and 940 (30.9%) controls. In multivariable models, no association was found between hospitalization for a fall-related injury and prior exposure to a ChEI in persons with dementia dispensed beta-blockers (adjusted odds ratio = .96, 95% confidence interval = .85-1.08). Findings were consistent across secondary exposures and subgroup analyses.
Among nursing home residents with dementia receiving beta-blockers, co-prescription of a ChEI was not associated with an increased risk of hospitalization for a fall-related injury. However, we did not assess for its association with falls not leading to hospitalization. This finding could inform clinical guidelines and shared decision making between persons with dementia, caregivers, and clinicians concerning ChEI initiation and/or discontinuation.
背景/目的：本研究旨在探讨在患有痴呆症并接受β受体阻滞剂治疗的人群中，因跌倒相关损伤而住院与同时开具胆碱酯酶抑制剂（ChEI）之间的关联，以及这种潜在的药物-药物相互作用是否会因衰弱而改变。
使用基于人群的行政数据库进行嵌套病例对照研究。
加拿大安大略省的所有养老院。
年龄在 66 岁及以上，在 2013 年 4 月至 2018 年 3 月养老院入院后至少接受过一次β受体阻滞剂治疗的痴呆症患者（n = 19060）。
病例为因跌倒相关损伤而住院（急诊就诊或急性住院）并同时使用β受体阻滞剂的痴呆症患者。每位病例（n = 3038）均通过年龄（±1 岁）、性别、队列入组年份、衰弱和跌倒相关损伤史与 1 名对照相匹配。使用多变量条件逻辑回归分析跌倒相关损伤与 90 天内暴露于 ChEI 之间的关联。次要暴露因素包括 ChEI 类型、日剂量、新发与现患使用以及 30 天内使用。亚组分析考虑了衰弱程度、年龄组、性别和跌倒相关损伤的住院史。
在过去 90 天内，947（31.2%）例患者和 940（30.9%）例对照患者接受了 ChEI 治疗。在多变量模型中，在接受β受体阻滞剂治疗的痴呆症患者中，跌倒相关损伤住院与之前暴露于 ChEI 之间无关联（调整后的优势比=0.96，95%置信区间=0.85-1.08）。次要暴露因素和亚组分析的结果一致。
在接受β受体阻滞剂治疗的养老院居民中，同时开具 ChEI 与跌倒相关损伤住院风险的增加无关。然而，我们并未评估其与未导致住院的跌倒之间的关联。这一发现可以为痴呆症患者、护理人员和临床医生在启动和/或停用 ChEI 方面提供临床指南和共同决策。
