Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea.
Korean J Intern Med. 2022 Mar;37(2):468-477. doi: 10.3904/kjim.2021.457. Epub 2022 Feb 18.
BACKGROUND/AIMS: Drugs with anticholinergic properties (DAPs) are associated with adverse health outcomes in older patients. The objective of this study was to evaluate the factors that determine the prescribing of more DAPs in long-term care hospitals (LTCHs) in Korea. In addition, the current patterns of DAP prescription were explored using a novel platform, which can collect data from LTCHs.
This was a Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) sub-study, which is a pragmatic, cluster-randomized, controlled trial. The Health-RESPECT platform was used to collect prescribed medication data of 466 patients (aged ≥ 65 years) from seven LTCHs. DAPs were identified using the Korean Anticholinergic Burden Scale (KABS). Physical frailty, cognitive function, functional status, and quality of life were evaluated.
Among 466 LTCH patients, 88.8% (n = 414) were prescribed DAPs, and the prevalence of high KABS (≥ 3) was 70.4% (n = 328). The drugs that contributed most to the total KABS were quetiapine (20.7%), chlorpheniramine (19.5%), tramadol (9.8%), cimetidine (5.8%), and furosemide (3.6%). Polypharmacy, higher body mass index, less dependence, better communication and cognitive functions, and poorer quality of life were associated with high KABS.
Although the patients with a high burden of DAPs were less dependent and had better cognitive and communication functions, they had poorer quality of life. DAP use in LTCH patients should be monitored carefully, and the risk/ benefit relationship for their use should be considered.
背景/目的：具有抗胆碱能特性的药物（DAP）与老年患者的不良健康结局相关。本研究的目的是评估决定韩国长期护理医院（LTCH）中开具更多 DAP 的因素。此外，还使用一种可以从 LTCH 收集数据的新型平台探索了 DAP 处方的当前模式。
这是一项 Health-RESPECT（使用 ICT 为老年患者整合护理系统）的子研究，是一项实用的、聚类随机对照试验。Health-RESPECT 平台用于从 7 家 LTCH 收集 466 名（年龄≥65 岁）患者的处方药物数据。使用韩国抗胆碱能负担量表（KABS）识别 DAP。评估身体虚弱、认知功能、功能状态和生活质量。
在 466 名 LTCH 患者中，88.8%（n=414）服用了 DAP，高 KABS（≥3）的患病率为 70.4%（n=328）。对总 KABS 贡献最大的药物是喹硫平（20.7%）、氯苯那敏（19.5%）、曲马多（9.8%）、西咪替丁（5.8%）和呋塞米（3.6%）。多药治疗、较高的体重指数、较少的依赖、更好的沟通和认知功能以及较差的生活质量与高 KABS 相关。
尽管 DAP 负担较重的患者依赖性较低且认知和沟通功能较好，但生活质量较差。应密切监测 LTCH 患者中 DAP 的使用，并考虑其使用的风险/效益关系。
