Disentangling drug contributions: anticholinergic burden in older adults linked to individual medications: a cross-sectional population-based study.
Disentangling drug contributions: anticholinergic burden in older adults linked to individual medications: a cross-sectional population-based study.
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DOI：
10.1186/s12877-023-04640-4
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发表时间：
2024-01-10
期刊：
影响因子：
4.1
通讯作者：
Lauffenburger, Julie C.
中科院分区：
文献类型：
--
作者：
Bhatkhande, Gauri;Choudhry, Niteesh K.;Mahesri, Mufaddal;Haff, Nancy;Lauffenburger, Julie C.
具有强效抗胆碱能特性的药物有充分的不良反应。由于同时使用多种抗胆碱能作用较弱的药物，可能会产生较高的累积抗胆碱能负担。我们试图确定高抗胆碱能负荷的模式和相关的患者特征。我们在一家美国大型健康保险公司中确定了年龄≥65岁、在2019年服用了≥1种抗胆碱能不良反应药物且累积抗胆碱能负担评分(ACB)≥4（即高抗胆碱能负担）的患者。我们根据患者达到高负担的程度对患者进行分类，如下：1)只服用强或中度抗胆碱能药物（即ACB = 2或3，“中等/强”），2)只服用轻度抗胆碱能药物（即ACB = 1，“轻/可能”），3)服用任何组合（“混合”）。我们使用多项逻辑回归来评估测量的患者特征与三种抗胆碱能负荷分类之间的关系，以中度/强组为参照。共有83,286例符合条件的高抗胆碱能负担患者（平均年龄：74.3岁（SD:7.1）， 72.9%为女性）。其中，4.5%仅填充强/中度抗胆碱能药物，4.3%仅填充轻度/可能的抗胆碱能药物，其余为混合（91.2%）。在混合组患者中，64.3%的药物填充为轻度/可能的抗胆碱能药物，35.7%为中度/强抗胆碱能药物。与中/强抗胆碱能药物组的患者相比，仅服用轻度/可能的抗胆碱能药物的患者更有可能是老年人（每1单位年龄的校正优势比[aOR]: 1.06, 95%CI: 1.05-1.07），女性的可能性更小（aOR: 0.56, 95%CI: 0.50-0.62，男性），更有可能出现合并症（例如，心力衰竭aOR: 3.18, 95%CI: 2.70-3.74或抑郁症aOR: 1.20, 95%CI: 1.09-1.33，无合并症），并且就诊的医生更少(每1单位变化的aOR：0.98, 95%ci: 0.97-0.98)。与服用中/强抗胆碱能药物的患者相比，混合组患者年龄较大（每单位年龄aOR: 1.02, 95%CI: 1.02 - 1.03），女性患者较少（aOR: 0.89, 95%CI: 0.82-0.97 vs.男性）。大多数老年人通过轻度/可能和中度/强抗胆碱能药物而不是中度/强抗胆碱能药物的组合积累了高抗胆碱能负担，轻度/可能的抗胆碱能药物是总体抗胆碱能负担的主要驱动因素。这些见解可能为干预措施提供信息，以改善老年人的处方。在线版本包含补充材料，可在10.1186/s12877-023-04640-4获得。
Medications with potent anticholinergic properties have well-documented adverse effects. A high cumulative anticholinergic burden may arise from the concurrent use of multiple medications with weaker anticholinergic effects. We sought to identify patterns of high anticholinergic burden and associated patient characteristics. We identified patients aged ≥ 65 who filled ≥ 1 medication with anticholinergic adverse effects in 2019 and had a cumulative Anticholinergic Burden score (ACB) ≥ 4 (i.e., high anticholinergic burden) in a large US health insurer. We classified patients based on how they attained high burden, as follows: 1) only filling strong or moderate anticholinergic medications (i.e., ACB = 2 or 3, “moderate/strong”), 2) only filling lightly anticholinergic medications (i.e., ACB = 1, “light/possible”), and 3) filling any combination (“mix”). We used multinomial logistic regression to assess the association between measured patient characteristics and membership in the three anticholinergic burden classifications, using the moderate/strong group as the referent. In total, 83,286 eligible patients with high anticholinergic burden were identified (mean age: 74.3 years (SD:7.1), 72.9% female). Of these, 4.5% filled only strong/moderate anticholinergics, 4.3% filled only light/possible anticholinergics, and the rest filled a mix (91.2%). Within patients in the mixed group, 64.3% of medication fills were for light/possible anticholinergics, while 35.7% were for moderate/strong anticholinergics. Compared with patients in the moderate/strong anticholinergics group, patients filling only light/possible anticholinergics were more likely to be older (adjusted Odds Ratio [aOR] per 1-unit of age: 1.06, 95%CI: 1.05–1.07), less likely to be female (aOR: 0.56, 95%CI: 0.50–0.62 vs. male), more likely to have comorbidities (e.g., heart failure aOR: 3.18, 95%CI: 2.70–3.74 or depression aOR: 1.20, 95%CI: 1.09–1.33 vs. no comorbidity), and visited fewer physicians (aOR per 1-unit of change: 0.98, 95%CI: 0.97–0.98). Patients in the mixed group were older (aOR per 1-unit of age: 1.02, 95%CI: 1.02–1.03) and less likely to be female (aOR: 0.89, 95%CI: 0.82–0.97 vs. male) compared with those filling moderate/strong anticholinergics. Most older adults accumulated high anticholinergic burden through a combination of light/possible and moderate/strong anticholinergics rather than moderate/strong anticholinergics, with light/possible anticholinergics being the major drivers of overall anticholinergic burden. These insights may inform interventions to improve prescribing in older adults. The online version contains supplementary material available at 10.1186/s12877-023-04640-4.
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影响因子：
2.9
作者：
Krüger C;Schäfer I;van den Bussche H;Bickel H;Fuchs A;Gensichen J;König HH;Maier W;Mergenthal K;Riedel-Heller SG;Schön G;Weyerer S;Wiese B;von Renteln-Kruse W;Langebrake C;Scherer M
通讯作者：
Scherer M
影响因子：
2.8
作者：
Green, Ariel R.;Reifler, Liza M.;Boyd, Cynthia M.
通讯作者：
Boyd, Cynthia M.
影响因子：
4.6
作者：
Cebron Lipovec, Nanca;Jazbar, Janja;Kos, Mitja
通讯作者：
Kos, Mitja
影响因子：
2.6
作者：
Block, Cady K.;Logue, Erin;Duff, Kevin
通讯作者：
Duff, Kevin
DOI：
10.3390/ijerph17113776
发表时间：
2020-06-01
影响因子：
--
作者：
Amoros-Reboredo, Patricia;Soy, Dolors;Mestres, Conxita
通讯作者：
Mestres, Conxita