Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study
Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study
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DOI：
10.1007/s40266-018-00630-z
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发表时间：
2019-03-01
期刊：
影响因子：
2.8
通讯作者：
Boyd, Cynthia M.
中科院分区：
文献类型：
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作者：
Green, Ariel R.;Reifler, Liza M.;Boyd, Cynthia M.
目前尚不清楚不同抗胆碱能评分的药物对总体抗胆碱能评分的贡献是否成比例。目的：我们的目的是评估认知受损人群中不同抗胆碱能评分药物的总体抗胆碱能评分与跌倒或跌倒相关损伤的风险的关系。方法：本研究是一项回顾性队列研究，纳入综合输送系统中患有轻度认知障碍（MCI）或痴呆以及两种或两种以上附加慢性疾病的65岁成人（N= 10698）。电子健康记录数据，包括药房填写和诊断声明，用于评估抗胆碱能药物使用情况，并使用抗胆碱能认知负担（ACB）量表、跌倒和跌倒相关损伤进行量化。结果在366天的中位随访期间，63%的队列患者使用了一种或多种ACB药物；2015年（18.8%）的人经历过跌倒或与跌倒相关的伤害。在每日ACB评分为5分的患者中，当2级和3级药物联合使用时，跌倒或跌倒相关损伤的风险增加最大[危险比（HR） 2.06；95%置信区间（CI） 1.51-2.83]。同时使用多种ACB 1级药物也增加了跌倒或跌倒相关损伤的风险（HR 1.16; 95% CI 1.03-1.32）。暴露于ACB 2级药物的跌倒或跌倒相关损伤风险（HR 1.56; 95% CI 1.16-2.10）高于暴露于ACB 1级或3级药物的风险。结论相同的每日ACB评分与不同程度的风险相关，这取决于构成评分的单个药物的ACB评分。与每日ACB评分相同的其他个体相比，2级和3级药物联合使用摔倒或跌倒相关损伤的风险最大。低效抗胆碱能药物一起适度服用会增加跌倒或跌倒相关损伤的危险。
BackgroundIt is not known whether drugs with different anticholinergic ratings contribute proportionately to overall anticholinergic score.ObjectivesOur objective was to assess the risk of falls or fall-related injuries as a function of the overall anticholinergic score resulting from drugs with different anticholinergic ratings among people with impaired cognition.MethodsThis was a retrospective cohort study of adults aged 65years with mild cognitive impairment (MCI) or dementia and two or more additional chronic conditions (N=10,698) in an integrated delivery system. Electronic health record data, including pharmacy fills and diagnosis claims, were used to assess anticholinergic medication use, quantified using the anticholinergic cognitive burden (ACB) scale, falls and fall-related injuries.ResultsDuring a median follow-up of 366days, 63% of the cohort used one or more ACB drug; 2015 (18.8%) people experienced a fall or fall-related injury. Among patients with a daily ACB score of 5, the greatest increase in risk of falls or fall-related injuries was seen when level 2 and level 3 drugs were used in combination [hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.51-2.83]. Multiple ACB level 1 drugs taken together alsoincreased the hazard of a fall or fall-related injury (HR 1.16; 95% CI 1.03-1.32). The risk of fall or fall-related injury as a function of exposure to ACB level 2 drugs (HR 1.56; 95% CI 1.16-2.10) was higher than that for ACB level 1 or 3 drugs.ConclusionsThe same daily ACB score was associated with a different degree of risk, depending on the ACB ratings of the individual drugs comprising the score. Combinations of level 2 and level 3 drugs had the greatest risk of fall or fall-related injury relative to other individuals with the same daily ACB score. Low-potency anticholinergic drugs taken together modestlyincreased the hazard of a fall or fall-related injury.