Potential Targets for Deprescribing in Medically Complex Older Adults with Suspected Cognitive Impairment.
Potential Targets for Deprescribing in Medically Complex Older Adults with Suspected Cognitive Impairment.
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DOI：
10.3390/geriatrics7030059
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发表时间：
2022-05-19
期刊：
影响因子：
2.3
通讯作者：
Hastings, Susan N.
中科院分区：
文献类型：
--
作者：
Pavon, Juliessa M.;Berkowitz, Theodore S. Z.;Smith, Valerie A.;Hughes, Jaime M.;Hung, Anna;Hastings, Susan N.
关键词：
对于病情复杂且疑似认知障碍 (CI) 的患者，取消处方可能特别有益。我们描述了该人群中中枢神经系统（CNS）药物的使用和副作用，并探讨了抗胆碱能负担与睡眠之间的关系。我们对一项试点随机对照试验的基线数据进行了横断面分析，该试验针对患有医疗复杂性（护理评估需求评分 > 90）和疑似 CI（认知状态评分 20-31 的电话访谈）的老年退伍军人。 CNS 药物类别包括抗精神病药、苯二氮卓类药物、H2 受体拮抗剂、安眠药、阿片类药物和骨骼肌松弛剂。我们还根据抗胆碱能认知负担（ACB）评分对抗胆碱能活性药物进行编码。其他指标包括自我报告的药物副作用和匹兹堡睡眠质量指数（PSQI）。使用调整后的线性回归检查 ACB 与睡眠 (PSQI) 的关联。在该样本中 (N = 40)，处方中枢神经系统药物的平均数量为 2.2 (SD 1.5)，65% 的人经历过 ≥ 1 种副作用，50% 的人 ACB 评分 ≥ 3（高抗胆碱能药物暴露）。与 ACB < 3 相比，ACB 评分 ≥ 3 与 PSQI 评分没有显着相关性（平均评分差异 = -0.1，95% CI -2.1，1.8）。尽管结果并未表明与睡眠恶化之间存在明确关系，但显着的副作用和抗胆碱能负担支持了该人群的减药需求。
Deprescribing may be particularly beneficial in patients with medical complexity and suspected cognitive impairment (CI). We describe central nervous system (CNS) medication use and side effects in this population and explore the relationship between anticholinergic burden and sleep. We conducted a cross-sectional analysis of baseline data from a pilot randomized-controlled trial in older adult veterans with medical complexity (Care Assessment Need score > 90), and suspected CI (Telephone Interview for Cognitive Status score 20–31). CNS medication classes included antipsychotics, benzodiazepines, H2-receptor antagonists, hypnotics, opioids, and skeletal muscle relaxants. We also coded anticholinergic-active medications according to their Anticholinergic Cognitive Burden (ACB) score. Other measures included self-reported medication side effects and the Pittsburgh Sleep Quality Index (PSQI). ACB association with sleep (PSQI) was examined using adjusted linear regression. In this sample (N = 40), the mean number of prescribed CNS medications was 2.2 (SD 1.5), 65% experienced ≥ 1 side effect, and 50% had an ACB score ≥ 3 (high anticholinergic exposure). The ACB score ≥ 3 compared to ACB < 3 was not significantly associated with PSQI scores (avg diff in score = −0.1, 95% CI −2.1, 1.8). Although results did not demonstrate a clear relationship with worsened sleep, significant side effects and anticholinergic burden support the deprescribing need in this population.
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影响因子：
39
作者：
Bayliss EA;Shetterly SM;Drace ML;Norton JD;Maiyani M;Gleason KS;Sawyer JK;Weffald LA;Green AR;Reeve E;Maciejewski ML;Sheehan OC;Wolff JL;Kraus C;Boyd CM
通讯作者：
Boyd CM
影响因子：
6.3
作者：
Hastings SN;Mahanna EP;Berkowitz TSZ;Smith VA;Choate AL;Hughes JM;Pavon J;Robinson K;Hendrix C;Van Houtven C;Gentry P;Rose C;Plassman BL;Potter G;Oddone E
通讯作者：
Oddone E
影响因子：
6.2
作者：
Doran, Kelly M.;Raven, Maria C.;Rosenheck, Robert A.
通讯作者：
Rosenheck, Robert A.
影响因子：
4.6
作者：
Cebron Lipovec, Nanca;Jazbar, Janja;Kos, Mitja
通讯作者：
Kos, Mitja
影响因子：
4.8
作者：
Landry GJ;Best JR;Liu-Ambrose T
通讯作者：
Liu-Ambrose T