Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
School of Healthcare, University of Leeds, Leeds, UK.
Age Ageing. 2023 Jul 1;52(7). doi: 10.1093/ageing/afad136.
Anticholinergic medicines are associated with adverse outcomes for older people. However, little is known about their use in frailty. The objectives were to (i) investigate the prevalence of anticholinergic prescribing for older patients, and (ii) examine anticholinergic burden according to frailty status.
Cross-sectional analysis of Welsh primary care data from the Secure Anonymised Information Linkage databank including patients aged ≥65 at their first GP consultation between 1 January and 31 December 2018. Frailty was identified using the electronic Frailty Index and anticholinergic burden using the Anticholinergic Cognitive Burden (ACB) scale. Descriptive analysis and logistic regression were conducted to (i) describe the type and frequency of anticholinergics prescribed; and (ii) to estimate the association between frailty and cumulative ACB score (ACB-Sum).
In this study of 529,095 patients, 47.4% of patients receiving any prescription medications were prescribed at least one anticholinergic medicine. Adjusted regression analysis showed that patients with increasing frailty had higher odds of having an ACB-Sum of >3 compared with patients who were fit (mild frailty, adj OR 1.062 (95%CI 1.061-1.064), moderate frailty, adj OR 1.134 (95%CI 1.131-1.136), severe frailty, adj OR 1.208 (95%CI 1.203-1.213)).
Anticholinergic prescribing was high in this older population. Older people with advancing frailty are exposed to the highest anticholinergic burden despite being the most vulnerable to the associated adverse effects. Older people with advancing frailty should be considered for medicines review to prevent overaccumulation of anticholinergic medications, given the risks of functional and cognitive decline that frailty presents.
抗胆碱能药物与老年人的不良结局有关。然而，关于它们在虚弱中的使用知之甚少。目的是（i）调查老年患者抗胆碱能药物的处方流行率，（ii）根据虚弱状况检查抗胆碱能负担。
使用来自威尔士初级保健数据的横断面分析，该数据来自 Secure Anonymised Information Linkage 数据库，包括 2018 年 1 月 1 日至 12 月 31 日期间首次在全科医生处就诊时年龄≥65 岁的患者。使用电子虚弱指数和抗胆碱能认知负担（ACB）量表来确定虚弱状况。进行描述性分析和逻辑回归分析，以（i）描述开出的抗胆碱能药物的类型和频率；（ii）估计虚弱与累积 ACB 评分（ACB-Sum）之间的关联。
在这项针对 529,095 名患者的研究中，47.4%接受任何处方药物的患者至少开出了一种抗胆碱能药物。调整后的回归分析表明，虚弱程度增加的患者与健康患者相比，ACB-Sum>3 的可能性更高（轻度虚弱，调整后的 OR 1.062（95%CI 1.061-1.064），中度虚弱，调整后的 OR 1.134（95%CI 1.131-1.136），严重虚弱，调整后的 OR 1.208（95%CI 1.203-1.213））。
在这个老年人群中，抗胆碱能药物的处方率很高。尽管脆弱的人最容易受到相关不良影响，但随着虚弱程度的增加，老年人面临着最高的抗胆碱能负担。鉴于虚弱症带来的功能和认知能力下降的风险，应考虑对虚弱程度增加的老年人进行药物审查，以防止抗胆碱能药物的过度积累。
