Drug Burden Index and physical function in older Australian men
Drug Burden Index and physical function in older Australian men
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DOI：
10.1111/j.1365-2125.2009.03411.x
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发表时间：
2009-07-01
影响因子：
3.4
通讯作者：
Hilmer, Sarah N.
中科院分区：
文献类型：
--
作者：
Gnjidic, Danijela;Cumming, Robert G.;Hilmer, Sarah N.
不当用药在老年人中很常见。使用具有抗胆碱能和镇静特性的药物与老年人的功能损伤有关。在美国的两项老年人研究中，使用药物负担指数（包括剂量反应原则和最大效果原则）测量抗胆碱能药物和镇静药物暴露与身体和认知功能损害有关。本研究内容：我们评估了澳大利亚社区老年男性人口的药物负担指数，Concord健康与老龄化男性项目随机招募了居住在澳大利亚悉尼的年龄为bb0 = 70岁的社区男性。在该人群中，药物负担指数的增加与身体机能和功能状态的客观损害有关。药物负担指数具有广泛的适用性，无论医疗保健制度、处方做法、性别或国家如何。目的：本研究评估澳大利亚老年男性身体表现和功能状态测量与药物负担指数的关系。药物负担指数是衡量抗胆碱能药物和镇静药物的总暴露量，它结合了剂量反应和最大效果的原则。方法对参加澳大利亚悉尼康科德健康与老龄化男性项目的社区老年男性进行横断面调查。结果包括椅子支架、6米以上步行速度、20厘米狭窄步行速度、平衡、握力和日常生活工具活动评分（IADLs）。结果研究人群包括1705名男性（76.9±5.5岁）。在报告服用药物的1527名（90%）参与者中，21%暴露于抗胆碱能药物，13%暴露于镇静药物。研究人群的平均药物负担指数为0.18±0.35。在调整混杂因素（社会人口统计学、合并症、认知障碍、抑郁）后，药物负担指数与行走速度较慢（P < 0.05）、狭窄行走速度较慢（P < 0.05）、平衡困难（P < 0.01）、握力无力（P < 0.01）和IADLs表现较差（P < 0.05）相关。与药物负担指数的抗胆碱能成分相比，镇静剂与身体机能和功能的关联更强。结论澳大利亚社区老年男性药物负担指数越高，身体机能状况越差。药物负担指数作为评估药物对决定老年人独立性的功能的影响的工具具有广泛的适用性。
center dot Inappropriate medication use is common among the elderly.center dot Use of medications with anticholinergic and sedative properties is associated with functional impairments in older people.center dot Exposure to anticholinergic and sedative medications, measured with Drug Burden Index that includes the principles of dose-response and maximal effect, was associated with impairment in physical and cognitive function in two studies of older people in the USA.WHAT THIS STUDY ADDScenter dot We evaluated Drug Burden Index in an Australian population of community-dwelling older men, The Concord Health and Ageing in Men Project that enrolled a random sample of community-dwelling men aged >= 70 years living in Sydney, Australia.center dot In this population, increasing Drug Burden Index was associated with objective impairments of physical performance and functional status.center dot The Drug Burden Index has broad applicability regardless of healthcare system, prescribing practices, gender or country.AIMSThis study evaluated the associations of physical performance and functional status measures with the Drug Burden Index in older Australian men. The Drug Burden Index is a measure of total exposure to anticholinergic and sedative medications that incorporates the principles of dose-response and maximal effect.METHODSA cross-sectional survey was performed on community-dwelling older men enrolled in The Concord Health and Ageing in Men Project, Sydney, Australia. Outcomes included chair stands, walking speed over 6 m, 20-cm narrow walk speed, balance, grip strength and Instrumental Activities of Daily Living score (IADLs).RESULTSThe study population consisted of 1705 men (age 76.9 +/- 5.5 years). Of the 1527 (90%) participants who reported taking medications, 21% were exposed to anticholinergic and 13% to sedative drugs. The average Drug Burden Index in the study population was 0.18 +/- 0.35. After adjusting for confounders (sociodemographics, comorbidities, cognitive impairment, depression), Drug Burden Index was associated with slower walking speed (P < 0.05), slower narrow walk speed (P < 0.05), balance difficulty (P < 0.01), grip weakness (P < 0.01) and poorer performance on IADLs (P < 0.05). Associations with physical performance and function were stronger for the sedative than for the anticholinergic component of the Drug Burden Index.CONCLUSIONSHigher Drug Burden Index is associated with poorer physical performance and functional status in community-dwelling older Australian men. The Drug Burden Index has broad applicability as a tool for assessing the impact of medications on functions that determine independence in older people.