Anticholinergic burden measures and older people's falls risk: a systematic prognostic review.
Anticholinergic burden measures and older people's falls risk: a systematic prognostic review.
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DOI：
10.1177/20420986211016645
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发表时间：
2021
影响因子：
4.4
通讯作者：
Myint PK
中科院分区：
文献类型：
--
作者：
Stewart C;Taylor-Rowan M;Soiza RL;Quinn TJ;Loke YK;Myint PK
一些不良后果与抗胆碱能负荷(ACB)有关，而且这些风险随着年龄的增加而增加。有几种方法可以衡量这种负担，但到目前为止，还没有对它们的预后能力进行比较。这项在Propero注册的系统综述(CRD42019115918)比较了ACB措施背后的证据与它们预测老年人跌倒风险的能力。对Medline(Ovid)、EMBASE(Ovid)、CINAHL(EMBSCO)和QicINFO(Ovid)进行全面搜索，并使用有效的搜索过滤器进行预后研究。纳入标准包括：受试者年龄65岁及以上，使用一种或多种 测量(S)作为预后因素，设计中的队列或病例对照，以及报告跌倒作为结果。使用预后研究质量(QUPS)工具评估偏倚风险。纳入了8项研究，报告了ACB和跌倒之间的时间相关性。所有研究都在⩾1 Quip工具类别中被评为高风险偏见，其中5项被评为高风险⩾3类别。所有研究(274,647名参与者)都表明，抗胆碱能评分与跌倒风险增加之间存在一定程度的关联。研究结果以中到高水平的ACB最为显著。大多数研究(6/8)使用了抗胆碱能认知负荷量表。没有研究直接比较两个或更多的ACB测量，而且在测量跌落进行分析的方式上也存在差异。证据支持中度到高度的ACB与老年人跌倒的风险之间的关联，但对于哪种ACB评分在老年人中提供了最好的预后价值，尚不能得出结论。对已发表的研究进行综述，以探索哪种抗胆碱能负荷量表最能预测老年人跌倒的风险。简介：三分之一的老年人会跌倒。跌倒会造成许多后果，包括骨折、丧失独立性和无法享受生活。很多事情都会增加摔倒的几率。这包括一些药物。一种被称为抗胆碱能药物的药物可能会增加跌倒的风险。这些药物被用来治疗常见的健康问题，包括抑郁症和膀胱问题。抗胆碱能负荷是用来描述服用这些药物的总效果的术语。有些人可能会使用不止一种药物。这将增加他们的抗胆碱能负担。减少这些药物的使用可能会降低跌倒的风险。我们需要进行研究，看看这是否可能。要做到这一点，我们需要能够测量抗胆碱能负荷。有几种天平可供选择，但我们不知道哪一种最好。方法：我们想要回答的问题是：在预测老年人跌倒的风险方面，哪种抗胆碱能量表最好？我们回顾了可以回答这一问题的研究。我们以一种系统的方式收集了所有已发表的研究。我们用几种方法限制了搜索。我们只纳入了与我们的问题相关的研究。结果：我们发现了8项研究。我们了解到，中度到高度使用这些药物的人(通常是将使用一种以上药物的人)跌倒的风险更高。目前尚不清楚的是，负担较轻的人(通常是只使用其中一种药物的人)摔倒的风险是否会增加。由于研究数量较少，我们无法确定一种量表是否优于另一种量表。结论：这些发现提示我们应该减少这些药物的使用。这可能会减少跌倒的次数，并改善老年人的福祉。
Several adverse outcomes have been associated with anticholinergic burden (ACB), and these risks increase with age. Several approaches to measuring this burden are available but, to date, no comparison of their prognostic abilities has been conducted. This PROSPERO-registered systematic review (CRD42019115918) compared the evidence behind ACB measures in relation to their ability to predict risk of falling in older people. Medline (OVID), EMBASE (OVID), CINAHL (EMBSCO) and PsycINFO (OVID) were searched using comprehensive search terms and a validated search filter for prognostic studies. Inclusion criteria included: participants aged 65 years and older, use of one or more ACB measure(s) as a prognostic factor, cohort or case-control in design, and reporting falls as an outcome. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Eight studies reporting temporal associations between ACB and falls were included. All studies were rated high risk of bias in ⩾1 QUIPS tool categories, with five rated high risk ⩾3 categories. All studies (274,647 participants) showed some degree of association between anticholinergic score and increased risk of falls. Findings were most significant with moderate to high levels of ACB. Most studies (6/8) utilised the anticholinergic cognitive burden scale. No studies directly compared two or more ACB measures and there was variation in how falls were measured for analysis. The evidence supports an association between moderate to high ACB and risk of falling in older people, but no conclusion can be made regarding which ACB scale offers best prognostic value in older people. A review of published studies to explore which anticholinergic burden scale is best at predicting the risk of falls in older people Introduction: One third of older people will experience a fall. Falls have many consequences including fractures, a loss of independence and being unable to enjoy life. Many things can increase the chances of having a fall. This includes some medications. One type of medication, known as anticholinergic medication, may increase the risk of falls. These medications are used to treat common health issues including depression and bladder problems. Anticholinergic burden is the term used to describe the total effects from taking these medications. Some people may use more than one of these medications. This would increase their anticholinergic burden. It is possible that reducing the use of these medications could reduce the risk of falls. We need to carry out studies to see if this is possible. To do this, we need to be able to measure anticholinergic burden. There are several scales available, but we do not know which is best. Methods: We wanted to answer: ‘Which anticholinergic scale is best at predicting the risk of falling in older people?’. We reviewed studies that could answer this. We did this in a systematic way to capture all published studies. We restricted the search in several ways. We only included studies relevant to our question. Results: We found eight studies. We learned that people who are moderate to high users of these medications (often people who will use more than one of these medications) had a higher risk of falling. It was less clear if people who have a lower burden (often people who only use one of these medications) had an increased risk of falling. The low number of studies prevented us from determining if one scale was better than another. Conclusion: These findings suggest that we should reduce use of these medications. This could reduce the number falls and improve the well-being of older people.
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帕金森病抗胆碱能负担与不良健康结果之间的关联。
影响因子：
3.7
作者：
Crispo JA;Willis AW;Thibault DP;Fortin Y;Hays HD;McNair DS;Bjerre LM;Kohen DE;Perez-Lloret S;Mattison DR;Krewski D
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通讯作者：
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影响因子：
2.8
作者：
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通讯作者：
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影响因子：
2.4
作者：
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通讯作者：
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影响因子：
3.9
作者：
Squires P;Pahor M;Manini TM;Vouri S;Brown JD
通讯作者：
Brown JD