Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women
Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women
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DOI：
10.1038/sj.clpt.6100303
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发表时间：
2008-03-01
影响因子：
6.7
通讯作者：
Abernethy, D. R.
中科院分区：
文献类型：
--
作者：
Cao, Y-J;Mager, D. E.;Abernethy, D. R.
老年人中常见的多种药物治疗既有不良后果的风险，也有益处。我们评估了具有抗胆碱能和镇静作用的常用处方药与老年人身体和认知能力的关系。研究人群包括932名65岁或以上的中度至重度残疾社区居民妇女，她们是妇女健康与老龄化研究I的参与者。开发了基于药效学原理的量表，并将其用作药物负荷的测量。这与身体和认知功能的测量有关。在调整人口统计学和合并症后，抗胆碱能药物负荷与四个身体功能领域的更大困难独立相关，具有调整后的比值比（95%置信区间（CI））为4.9（2.0-12.0）平衡困难; 3.2（1.5-6.9）行动困难; 3.6（1.6-8.0）缓慢步态; 4.2（2.0-8.7）椅子站立困难; 2.4（1.1-5.3）握力弱; 2.7（1.3-5.4）上肢受限; 3.4（1.7-6.9）为日常生活活动困难;和2.4（95% CI，1.1-5.1）为简易精神状态检查表现不佳。镇静负荷仅与握力受损（3.3（1.5-7.3））和活动困难（2.4（1.1-5.3））相关。多种药物的负担可以通过合并推荐的剂量方案和实际剂量以及药物服用频率来量化。抗胆碱能药物负荷与身体和认知功能的限制密切相关。镇静负荷与更有限领域的功能受损相关。与易受伤害的老年妇女接触具有抗胆碱能特性的药物相关的风险，以及在较小程度上具有镇静特性的药物，意味着此类药物不应用于该患者群体，除非有令人信服的临床指征。
Polypharmacy, common in older people, confers both risk of adverse outcomes and benefits. We assessed the relationship of commonly prescribed medications with anticholinergic and sedative effects to physical and cognitive performance in older individuals. The study population comprised 932 moderately to severely disabled community-resident women aged 65 years or older who were participants in the Women's Health and Aging Study I. A scale based on pharmacodynamic principles was developed and utilized as a measure of drug burden. This was related to measures of physical and cognitive function. After adjusting for demographics and comorbidities, anticholinergic drug burden was independently associated with greater difficulty in four physical function domains with adjusted odds ratios (95% confidence interval (CI)) of 4.9 (2.0-12.0) for balance difficulty; 3.2 (1.5-6.9) for mobility difficulty; 3.6 (1.6-8.0) for slow gait; 4.2 (2.0-8.7) for chair stands difficulty; 2.4 (1.1-5.3) for weak grip strength; 2.7 (1.3-5.4) for upper extremity limitations; 3.4 (1.7-6.9) for difficulty in activities of daily living; and 2.4 (95% CI, 1.1-5.1) for poor performance on the Mini-Mental State Examination. Sedative burden was associated only with impaired grip strength (3.3 (1.5-7.3)) and mobility difficulty (2.4 (1.1-5.3)). The burden of multiple drugs can be quantified by incorporating the recommended dose regimen and the actual dose and frequency of drug taken. Anticholinergic drug burden is strongly associated with limitations in physical and cognitive function. Sedative burden is associated with impaired functioning in more limited domains. The risk associated with exposure of vulnerable older women to drugs with anticholinergic properties, and to a lesser extent those with sedative properties, implies that such drugs should not be used in this patient group without compelling clinical indication.