Debain Aziz, Loosveldt Fien, Knoop Veerle, Costenoble Axelle, Saren Jordy, Petrovic Mirko, Bautmans Ivan
Frailty & Resilience in Ageing Research Unit, Vitality Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels, Belgium.
Drugs Aging. 2025 May;42(5):445-456. doi: 10.1007/s40266-025-01200-w. Epub 2025 Mar 29.
Both autonomic dysfunction and frailty are common and complex geriatric syndromes with similar negative health outcomes. Both conditions are characterized by a loss of homeostasis that makes individuals more vulnerable to stressors.
The primary aim of this study is to examine the association between drugs that affect autonomic function and frailty onset in community-dwelling octogenarians. The secondary aim is to investigate the relationship between autonomic dysfunction and frailty onset in this population.
In total, 372 nonfrail adults aged 80 years and above (mean age 83 ± 3 years) from the BUTTERFLY project were prospectively followed for 2 years (mean follow-up of 22 ± 6 months). The association between autonomic dysfunction (defined as neurogenic orthostatic hypotension and symptoms of orthostatic hypotension), the use of medications affecting autonomic function, and frailty status were examined using binary logistic regression analysis.
The completely adjusted binary logistic regression model showed that the use of drugs affecting autonomic function was associated with frailty {adjusted odds ratio (aOR) = 1.78 [95% confidence interval (CI) 1.06-3.00], p = 0.030}. Furthermore, symptoms of orthostatic hypotension were related to frailty (aOR = 2.98 [95% CI 1.13-7.88], p = 0.027).
Our results show that symptoms of orthostatic hypotension and the use of drugs that affect autonomic function are accompanied with respectively 3-fold and 1.8-fold higher odds of frailty onset in persons aged 80 years and over. Therefore, pharmacological treatment that affects autonomic function should be started with caution and timely discontinued in older persons.
自主神经功能障碍和衰弱都是常见且复杂的老年综合征，具有相似的不良健康结局。这两种情况都以体内稳态丧失为特征，使个体更容易受到应激源的影响。
本研究的主要目的是检验影响自主神经功能的药物与社区居住的八旬老人衰弱发生之间的关联。次要目的是调查该人群中自主神经功能障碍与衰弱发生之间的关系。
来自BUTTERFLY项目的372名80岁及以上的非衰弱成年人（平均年龄83±3岁）被前瞻性随访2年（平均随访22±6个月）。使用二元逻辑回归分析检验自主神经功能障碍（定义为神经源性直立性低血压和直立性低血压症状）、影响自主神经功能的药物使用与衰弱状态之间的关联。
完全调整后的二元逻辑回归模型显示，使用影响自主神经功能的药物与衰弱相关{调整后的优势比（aOR）=1.78[95%置信区间（CI）1.06 - 3.00]，p = 0.030}。此外，直立性低血压症状与衰弱有关（aOR = 2.98[95%CI 1.13 - 7.88]，p = 0.027）。
我们的结果表明，直立性低血压症状和影响自主神经功能的药物使用分别使80岁及以上人群衰弱发生的几率高出3倍和1.8倍。因此，影响自主神经功能的药物治疗在老年人中应谨慎开始并及时停药。
