Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study.
Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study.
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DOI：
10.3390/jcm9092989
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发表时间：
2020-09-16
影响因子：
3.9
通讯作者：
Brown JD
中科院分区：
文献类型：
--
作者：
Squires P;Pahor M;Manini TM;Vouri S;Brown JD
抗胆碱能认知负荷(ACB)可能与老年人行动能力和身体独立性的不利影响有关。我们根据不同的抗胆碱能负荷水平评估了老年人生活方式干预(LIFE)试验中参与者的主要行动能力障碍(MMD)、持续性主要活动能力障碍(PMMD)和损伤性跌倒的发生率。年龄在70-89岁的参与者被随机分为体力活动(PA)或成功老龄化(SA)干预，并通过ACB药物使用作为先前开发的ACB量表的总分进行评估。混杂因素包括人口统计特征、身体功能、认知功能和跌倒史。参与者的平均随访时间为2.6年，包括每6个月对MMD、PMMD和损伤性跌倒的结果评估。调整后的比例风险模型评估了ACB评分的独立影响以及与干预的交互影响。在1635名参与者中，986人(60%)使用了≥-1抗胆碱能药物。与没有负担的参与者相比，ACB评分为1的参与者MMD(HR=1.42[1.13-1.78])、PMMD(HR=1.53[1.12-2.09])和损伤性跌倒(HR=1.60[1.10-2.32])增加。结果与无负荷组相比，所有其他ACB水平的大小相似。ACB组之间的逐步剂量-反应比较没有显示出显著的结果差异。PA或SA干预的分层显示，与合并的总体试验结果相比，差异不大。与不服用抗胆碱能药物的参与者相比，服用抗胆碱能药物的参与者通常表现出MMD、PMMD和损伤性跌倒的风险增加。总的抗胆碱能负荷与行动不便的逐步剂量-反应关系无关，并且可能对捕捉不同的反应缺乏敏感性。
Anticholinergic cognitive burden (ACB) may be associated with detrimental effects on mobility and physical independence in older adults. We evaluated the incidence of major mobility disability (MMD), persistent major mobility disability (PMMD), and injurious falls among participants within the Lifestyle Interventions for Elders (LIFE) trial according to varied anticholinergic burden levels. Participants aged 70–89 years were randomized to a physical activity (PA) or successful aging (SA) intervention and evaluated by ACB medication use as a summed score of a previously developed ACB scale. Confounders included demographic characteristics, physical function, cognitive function, and fall history. Average participant follow-up was 2.6 years and included outcome assessment for MMD, PMMD, and injurious falls every six months. Adjusted proportional hazards models evaluated the independent effects of ACB scores as well as interaction effects with the intervention. Of the 1635 participants, 986 (60%) used ≥1 anticholinergic medication. Compared to those with no burden, participants with an ACB score of 1 demonstrated increased MMD (HR = 1.42 [1.13–1.78]), PMMD (HR = 1.53 [1.12–2.09]), and injurious falls (HR = 1.60 [1.10–2.32]). Results similar in magnitude were observed for all other ACB levels versus the no burden group. Stepwise dose–response comparisons between ACB groupings did not demonstrate significant differences in outcomes. Stratification by PA or SA interventions demonstrated few differences from the combined overall trial results. Compared to those not taking anticholinergic medications, participants taking anticholinergic medications generally demonstrated increased risk of MMD, PMMD, and injurious falls. Total anticholinergic burden was not associated with a stepwise dose–response relationship in mobility disability and may lack sensitivity to capture varied responses.
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