Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study.
Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study.
复制标题
DOI：
10.1186/s12877-016-0336-9
复制
发表时间：
2016-09-21
期刊：
影响因子：
4.1
通讯作者：
Jackson TA
中科院分区：
文献类型：
--
作者：
Moorey HC;Zaidman S;Jackson TA
老年人通常会服用多种药物，包括具有抗胆碱能作用的药物。多种药物和抗胆碱能药物可能是发生谵妄的危险因素。对来自入院单位的 70 岁以上、经 DSM-IV 诊断为谵妄的患者和无谵妄的患者进行了调查。从电子处方记录中记录入院时开出的药物数量和使用两种量表（抗胆碱能认知负担量表 [ACB] 和抗胆碱能药物量表 [ADS]）的抗胆碱能负担。探讨了它们之间的关系和预测能力。样本包括 125 名经 DSM-IV 诊断为谵妄的患者和 122 名没有谵妄的患者。样本的平均年龄为 84.0 岁。所开药物的中位数为 7 种：79.8% 开出 ≥5 种药物，29.0% 开出 ≥10 种药物。 ACB 评分中位数为 1，ADS 评分中位数为 1.5。 73.4% 的患者 ACB 评分≥1，73.0% 的 ADS 评分≥1。处方药物数量、多重用药率、过度多重用药率、ACB 评分和 ADS 评分以及入院时谵妄诊断之间没有关联。仅使用乙酰胆碱酯酶抑制剂可预测谵妄（OR 3.86，p = 0.04），并且处方药物数量与年龄呈负相关（spearman rho = −0.18，p = 0.006）。处方药物数量、多药治疗或抗胆碱能负担均与入院时谵妄无关，这对抗胆碱能药物量表的临床有效性提出了质疑。需要进一步的研究来充分阐明药物、抗胆碱能负担、年龄和老年患者中普遍存在的谵妄之间的关系，以及这些量表在临床实践中是否有任何作用。本文的在线版本 (doi:10.1186/s12877-016-0336-9) 包含补充材料，可供授权用户使用。
Older people are commonly prescribed multiple medications, including medications with anticholinergic effects. Polypharmacy and anticholinergic medications may be risk factors for the development of delirium. Patients from a medical admission unit who were over 70, with DSM-IV diagnosed delirium and patients without delirium, were investigated. Number of drugs prescribed on admission and anticholinergic burden using two scales (the Anticholinergic Cognitive Burden Scale [ACB] and the Anticholinergic Drug Scale [ADS]) were recorded from electronic prescribing records. The relationship and predictive ability of these were explored. The sample included 125 patients with DSM-IV diagnosed delirium and 122 patients without delirium. The mean age of the sample was 84.0 years. The median number of drugs prescribed was 7: 79.8 % were prescribed ≥5 drugs and 29.0 % ≥10 drugs. The median ACB score was 1 and the median ADS score was 1.5. 73.4 % of patients had an ACB score of ≥1 and 73.0 % had a ADS score ≥1. There was no association between: number of drugs prescribed, rate of polypharmacy, rate of excessive polypharmacy, ACB score and ADS score, and a diagnosis of delirium on admission. Only acetylcholinesterase inhibitor use predicted delirium (OR 3.86, p = 0.04) and the number of drugs prescribed was negatively correlated with age (spearman rho = −0.18, p = 0.006). Neither number of drugs prescribed, polypharmacy or anticholinergic burden were associated with delirium on admission, questioning the clinical usefulness of anticholinergic drug scales. Further research is needed to unpick fully the relationship between, drugs, anticholinergic burden, age, and prevalent delirium in older patients and whether there is any role for these scales in clinical practice. The online version of this article (doi:10.1186/s12877-016-0336-9) contains supplementary material, which is available to authorized users.