O'Leary Claire E T, Wilkinson Timothy J, Hanger H Carl
Older Persons Health, Te Whatu Ora (Health New Zealand)-Waitaha, Burwood Hospital, Christchurch, New Zealand.
Department of Medicine, University of Otago, Christchurch, New Zealand.
Australas J Ageing. 2024 Dec;43(4):706-714. doi: 10.1111/ajag.13333. Epub 2024 May 21.
Older inpatients who fall are often frail, with multiple co-morbidities and polypharmacy. Although the causes of falls are multifactorial, sedating and delirium-inducing drugs increase that risk. The aims were to determine whether people who fell had a change in their sedative and anticholinergic medication burden during an admission compared to people who did not fall. A secondary aim was to determine the factors associated with change in drug burden.
A retrospective, observational, case-control study of inpatients who fell. Two hundred consecutive people who fell were compared with 200 randomly selected people who had not fallen. Demographics, functional ability, frailty and cognition were recorded. For each patient, their total medications and anticholinergic and sedative burden were calculated on admission and on discharge, using the drug burden index (DBI).
People who fell were more dependent and cognitively impaired than people who did not fallen. People who fell had a higher DBI on admission, than people who had not fall (mean: .69 vs .43, respectively, p < .001) and discharge (.66 vs .38, p < .001). For both cohorts, the DBI decreased between admission and discharge (-.03 and -.05), but neither were clinically significant. Higher total medications and a higher number DBI medications on admission were both associated with greater DBI changes (p = .003 and <.001, respectively). However, the presence (or absence) of cognitive impairment, dependency, frailty and single vs multiple falls were not significantly associated with DBI changes.
In older people, DBI medications and falls are both common and have serious consequences, yet this study was unable to demonstrate any clinically relevant reduction in average DBI either in people who fell or people who had not fallen during a hospital admission.
老年住院患者跌倒往往身体虚弱，伴有多种合并症且用药繁杂。尽管跌倒原因是多因素的，但镇静和致谵妄药物会增加跌倒风险。本研究旨在确定与未跌倒的患者相比，跌倒患者在住院期间其镇静和抗胆碱能药物负担是否有变化。次要目的是确定与药物负担变化相关的因素。
对跌倒的住院患者进行一项回顾性、观察性病例对照研究。将连续200例跌倒患者与随机选取的200例未跌倒患者进行比较。记录人口统计学信息、功能能力、身体虚弱程度和认知情况。对于每位患者，使用药物负担指数（DBI）在入院时和出院时计算其总用药量以及抗胆碱能和镇静负担。
跌倒患者比未跌倒患者更依赖他人且认知受损。跌倒患者入院时的DBI高于未跌倒患者（均值分别为0.69和0.43，p < 0.001），出院时也是如此（0.66对0.38，p < 0.001）。对于两个队列，DBI在入院和出院之间均有所下降（分别为 -0.03和 -0.05），但均无临床意义。入院时总用药量较高和DBI用药数量较多均与DBI变化较大相关（分别为p = 0.003和p < 0.001）。然而，认知障碍的存在（或不存在）、依赖性、身体虚弱程度以及单次跌倒与多次跌倒与DBI变化均无显著关联。
在老年人中，DBI用药和跌倒都很常见且后果严重，但本研究未能证明在住院期间跌倒患者或未跌倒患者的平均DBI有任何临床相关的降低。
