Xu Xiang Jiang, Myint Phyo Kyaw, Kioh Sheng Hui, Mat Sumaiyah, Rajasuriar Reena, Kamaruzzaman Shahrul Bahyah, Tan Maw Pin
Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Ageing Clinical & Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom.
Arch Gerontol Geriatr. 2022 Jan-Feb;98:104535. doi: 10.1016/j.archger.2021.104535. Epub 2021 Sep 30.
While anticholinergic use is associated with stroke, dementia and mortality, few have evaluated its potential link with falls. To determine the relationship between anticholinergic cognitive burden (ACB) and falls over five years using the Malaysian Elders Longitudinal Research (MELoR).
Community-dwelling adults aged 55 years and over were recruited through electoral roll sampling. Data obtained at baseline and follow-up (FU) at two and five years were included. Falls in the preceding 12 months were recorded.
Of the 1499 individuals (mean (SD) age= 68.9(7.5) yrs and 53.3% female) with information on baseline ACB exposure, 575(38.4%) had ACB scores of 1-2 and 117(7.8%) had ACB scores ≥3. Differences in age, ethnicity, smoking status, diabetes, hypertension, cardiovascular disease, arthritis and education existed between ACB groups. Fall occurrence differed between ACB groups at recruitment (p = 0.004) and 2-year FU (p = 0.001) but not at 5-year FU (p = 0.053). Logistic regression revealed an independent association between ACB 1-2 and falls at baseline (odds ratio, OR (95% confidence interval, CI) =1.412(1.035-1.926)) and ACB≥3 and falls at 2-yr FU (OR (95%CI) =2.098(1.032-4.263)) following adjustment for confounders.
Low level exposure to drugs with anticholinergic properties was associated cross-sectionally with falls, while exposure to higher levels were prospectively associated with falls at 2-year but not at 5-year FU. Future studies should determine whether avoidance of drugs with anticholinergic effects will lead to reduction in falls.
虽然使用抗胆碱能药物与中风、痴呆和死亡率相关，但很少有人评估其与跌倒之间的潜在联系。利用马来西亚老年人纵向研究（MELoR）来确定抗胆碱能认知负担（ACB）与五年内跌倒之间的关系。
通过选民名册抽样招募55岁及以上的社区居住成年人。纳入在基线以及两年和五年随访（FU）时获得的数据。记录前12个月内的跌倒情况。
在1499名有基线ACB暴露信息的个体中（平均（标准差）年龄 = 68.9（7.5）岁，女性占53.3%），575人（38.4%）的ACB评分为1 - 2，117人（7.8%）的ACB评分≥3。ACB组之间在年龄、种族、吸烟状况、糖尿病、高血压、心血管疾病、关节炎和教育程度方面存在差异。在招募时（p = 0.004）和两年随访时（p = 0.001），ACB组之间的跌倒发生率存在差异，但在五年随访时无差异（p = 0.053）。逻辑回归显示，在对混杂因素进行调整后，ACB 1 - 2与基线时的跌倒之间存在独立关联（比值比，OR（95%置信区间，CI）= 1.412（1.035 - 1.926）），ACB≥3与两年随访时的跌倒之间存在独立关联（OR（95%CI）= 2.098（1.032 - 4.263））。
低水平接触具有抗胆碱能特性的药物与跌倒呈横断面关联，而高水平接触在两年随访时与跌倒呈前瞻性关联，但在五年随访时无此关联。未来的研究应确定避免使用具有抗胆碱能作用的药物是否会导致跌倒减少。
