The Association Between Drug Burden Index (DBI) and Health-Related Outcomes: A Longitudinal Study of the 'Oldest Old' (LiLACS NZ)
The Association Between Drug Burden Index (DBI) and Health-Related Outcomes: A Longitudinal Study of the 'Oldest Old' (LiLACS NZ)
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DOI：
10.1007/s40266-019-00735-z
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发表时间：
2020-03-01
期刊：
影响因子：
2.8
通讯作者：
Hughes, Carmel M.
中科院分区：
文献类型：
--
作者：
Cardwell, Karen;Kerse, Ngaire;Hughes, Carmel M.
背景 具有抗胆碱能和/或镇静特性的药物被认为可能不适合老年人（由于其副作用），药物负担指数（DBI）是一种基于证据的工具，用于衡量这些药物的暴露情况。高龄生活：新西兰队列研究 (LiLACS NZ) 是一项正在进行的纵向研究，旨在调查健康老龄化的决定因素。本研究利用 LiLACS NZ 的数据，旨在确定较高的 DBI 是否与 36 个月随访期间的较差结果（住院、跌倒、死亡率以及认知功能和功能状态）相关。方法 LiLACS NZ 由两个队列组成：年龄≥ 80 岁的毛利人（新西兰土著居民）和入组时年龄为 85 岁的非毛利人。本研究使用了基线、12 个月和 24 个月时定期处方药物的相关数据。使用新西兰医学专业月度索引 (MIMS) 药物处方集确定具有抗胆碱能和/或镇静特性的药物（即 DBI > 0 的药物）。 DBI 是针对每个时间点登记的每个人进行计算的。通过一系列 12 个月的随访，使用负二项式（住院和跌倒）、Cox（死亡率）和线性（认知功能和功能状态）回归分析评估基线 DBI 与结果之间的关联（显着性 p < 0.05）。回归模型根据年龄、性别、全科医生 (GP) 就诊次数、社会经济剥夺、处方药物数量以及以下一项进行调整：既往住院史、跌倒史、基线认知功能 [改良简易精神状态检查 (3MS)] 或基线功能状态 [诺丁汉日常生活扩展活动 (NEADL)]。结果 分别获得了 671 名、510 名和 403 名个体在基线、12 个月和 24 个月时的完整人口统计数据。总体而言，分别有 31%、30% 和 34% 的个体在基线、12 个月和 24 个月时服用 DBI > 0 的药物。在基线和 12 个月时，非毛利人的平均 DBI（分别为 0.28 +/- 0.5 和 0.27 +/- 0.5）高于毛利人（分别为 0.16 +/- 0.3 和 0.18 +/- 0.5）。基线时，DBI > 0 的最常用处方药物是佐匹克隆、多沙唑嗪、阿米替林和可待因。在毛利人中，较高的 DBI 与较高的死亡风险显着相关：在 36 个月的随访中，调整后的风险比 [95% 置信区间 (CI)] 1.89 (1.11-3.20)，p = 0.02。在非毛利人中，较高的 DBI 与较高的死亡风险显着相关[在 12 个月的随访中，调整后的风险比 (95% CI) 2.26 (1.09-4.70)，p = 0.03] 和认知功能受损[在 24 个月的随访中，调整后的 3MS 评分平均差 (95% CI) 0.89 (- 3.89 至 - 0.41)，p = 0.02）。结论 根据 LiLACS NZ 的数据，较高的 DBI 与较高的死亡率（毛利人和非毛利人）和认知功能受损（非毛利人）风险显着相关。这凸显了采用策略来管理老年人 DBI > 0 的药物处方的重要性。
Background The prescribing of medications with anticholinergic and/or sedative properties is considered potentially inappropriate in older people (due to their side-effect profile), and the Drug Burden Index (DBI) is an evidence-based tool which measures exposure to these medications. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is an ongoing longitudinal study investigating the determinants of healthy ageing. Using data from LiLACS NZ, this study aimed to determine whether a higher DBI was associated with poorer outcomes (hospitalisation, falls, mortality and cognitive function and functional status) over 36 months follow-up. Methods LiLACS NZ consists of two cohorts: Maori (the indigenous population of New Zealand) aged >= 80 years and non-Maori aged 85 years at the time of enrolment. Data relating to regularly prescribed medications at baseline, 12 months and 24 months were used in this study. Medications with anticholinergic and/or sedative properties (i.e. medications with a DBI > 0) were identified using the Monthly Index of Medical Specialities (MIMS) medication formulary, New Zealand. DBI was calculated for everyone enrolled at each time point. The association between DBI at baseline and outcomes was evaluated throughout a series of 12-month follow-ups using negative binomial (hospitalisations and falls), Cox (mortality) and linear (cognitive function and functional status) regression analyses (significance p < 0.05). Regression models were adjusted for age, gender, general practitioner (GP) visits, socioeconomic deprivation, number of medicines prescribed and one of the following: prior hospitalisation, history of falls, baseline cognitive function [Modified Mini-Mental State Examination (3MS)] or baseline functional status [Nottingham Extended Activities of Daily Living (NEADL)]. Results Full demographic data were obtained for 671, 510 and 403 individuals at baseline, 12 months and 24 months, respectively. Overall, 31%, 30% and 34% of individuals were prescribed a medication with a DBI > 0 at baseline, 12 months and 24 months, respectively. At baseline and 12 months, non-Maori had a greater mean DBI (0.28 +/- 0.5 and 0.27 +/- 0.5, respectively) compared to Maori (0.16 +/- 0.3 and 0.18 +/- 0.5, respectively). At baseline, the most commonly prescribed medicines with a DBI > 0 were zopiclone, doxazosin, amitriptyline and codeine. In Maori, a higher DBI was significantly associated with a greater risk of mortality: at 36 months follow-up, adjusted hazard ratio [95% confidence interval (CI)] 1.89 (1.11-3.20), p = 0.02. In non-Maori, a higher DBI was significantly associated with a greater risk of mortality [at 12 months follow-up, adjusted hazard ratio (95% CIs) 2.26 (1.09-4.70), p = 0.03] and impaired cognitive function [at 24 months follow-up, adjusted mean difference in 3MS score (95% CIs) 0.89 (- 3.89 to - 0.41), p = 0.02). Conclusions Using data from LiLACS NZ, a higher DBI was significantly associated with a greater risk of mortality (in Maori and non-Maori) and impaired cognitive function (in non-Maori). This highlights the importance of employing strategies to manage the prescribing of medications with a DBI > 0 in older adults.