The anticholinergic risk scale and anticholinergic adverse effects in older persons
The anticholinergic risk scale and anticholinergic adverse effects in older persons
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DOI：
10.1001/archinternmed.2007.106
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发表时间：
2008-03-10
影响因子：
--
通讯作者：
McGlinchey, Regina E.
中科院分区：
文献类型：
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作者：
Rudolph, James L.;Salow, Marci J.;McGlinchey, Regina E.
背景资料：抗胆碱能药物的不良反应可能导致老年患者发生福尔斯、谵妄和认知障碍等事件。为了进一步评估这种风险，我们开发了抗胆碱能风险量表（ARS），这是一个具有抗胆碱能潜力的常用处方药的分类列表。本研究的目的是确定是否可以使用ARS评分来预测抗胆碱能药物的不良反应的风险，在老年评估和管理（GEM）队列和初级careohol.Methods：回顾性分析了132例GEM患者的病历，包括药物的ARS和其可能产生的抗胆碱能药物的不良反应。因此，我们在初级保健诊所招募了117名65岁或以上的患者;进行药物调节;并询问抗胆碱能药物的不良反应。ARS评分与抗胆碱能药物不良反应风险之间的关系采用Poisson回归分析进行评估。结果：在GEM队列中，较高的ARS评分与抗胆碱能药物不良反应风险增加相关（粗相对危险度[RR]，1.5; 95%置信区间[CI]，1.3-1.8）和初级保健队列（粗RR，1.9; 95% CI，1.5-2.4）。在调整年龄和药物数量后，较高的ARS评分增加了GEM队列中抗胆碱能药物不良反应的风险（校正RR，1.3; 95% CI，1.1-1.6; c统计量，0.74）和初级保健队列（校正后的RR，1.9; 95%CI，1.5-2.5; c统计量，0.77）。结论：较高的ARS评分与老年患者中抗胆碱能药物不良反应的风险在统计学上显著增加相关。
Background: Adverse effects of anticholinergic medications may contribute to events such as falls, delirium, and cognitive impairment in older patients. To further assess this risk, we developed the Anticholinergic Risk Scale (ARS), a ranked categorical list of commonly prescribed medications with anticholinergic potential. The objective of this study was to determine if the ARS score could be used to predict the risk of anticholinergic adverse effects in a geriatric evaluation and management (GEM) cohort and in a primary care cohort.Methods: Medical records of 132 GEM patients were reviewed retrospectively for medications included on the ARS and their resultant possible anticholinergic adverse effects. Prospectively, we enrolled 117 patients, 65 years or older, in primary care clinics; performed medication reconciliation; and asked about anticholinergic adverse effects. The relationship between the ARS score and the risk of anticholinergic adverse effects was assessed using Poisson regression analysis.Results: Higher ARS scores were associated with increased risk of anticholinergic adverse effects in the GEM cohort (crude relative risk [RR], 1.5; 95% confidence interval [CI], 1.3-1.8) and in the primary care cohort (crude RR, 1.9; 95% CI, 1.5-2.4). After adjustment for age and the number of medications, higher ARS scores increased the risk of anticholinergic adverse effects in the GEM cohort (adjusted RR, 1.3; 95% CI, 1.1-1.6; c statistic, 0.74) and in the primary care cohort (adjusted RR, 1.9; 95% CI, 1.5-2.5; c statistic, 0.77).Conclusion: Higher ARS scores are associated with statistically significantly increased risk of anticholinergic adverse effects in older patients.