老年轻度认知障碍或痴呆患者抗胆碱能负担及其与住院风险和入院原因的关系

IF 3.7 3区 医学 Q2 GERIATRICS & GERONTOLOGY
Clinical Interventions in Aging Pub Date : 2025-09-25 eCollection Date: 2025-01-01 DOI:10.2147/CIA.S541108
Renuka Rahoo, Zhen Yi Liau, Min-Jie Low, Shahrul Bahyah Kamaruzzaman, Benedict Francis, Hui Min Khor
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引用次数: 0

摘要

背景:有认知障碍的老年人容易受到累积使用抗胆碱能药物的不良影响。然而,现有的关于这一人群住院风险的研究仍然有限,而且往往缺乏对入院具体原因的关注。本研究旨在探讨轻度认知障碍或痴呆老年人抗胆碱能负担的作用及其与住院风险和住院原因的关系。方法:这项回顾性研究纳入了2022年1月至12月期间在记忆诊所就诊的轻度认知障碍或痴呆的老年人。从电子病历中收集的数据包括社会人口统计信息、合并症、认知和功能评估、神经精神症状和用药史。采用抗胆碱能认知负担(ACB)评分评估抗胆碱能负担。采用Cox比例风险分析来评估ACB评分与住院风险之间的关系。在不同的ACB评分组之间比较住院的潜在原因。结果:共有657名老年人纳入分析,平均年龄为80.66岁(SD 7.39)。35.5%的患者使用抗胆碱能药物,平均ACB评分为0.8 (SD为1.3)。与无抗胆碱能负担的患者相比,较高的ACB评分与养老院居住、神经精神症状、较差的认知和身体功能以及较多的处方药物有关。单变量分析中,ACB评分为1-2分的老年人住院风险增加(风险比(HR)=1.84,95% CI:1.17-2.90),但在调整混杂因素后,这种关联减弱。最常见的住院原因是肺炎(5.7%)、急性肾损伤(3.8%)、谵妄(2.6%)和跌倒(2.6%)。值得注意的是,因严重心血管不良事件或感染性压疮住院的患者ACB评分明显较高。结论:三分之一患有轻度认知障碍或痴呆的老年人使用抗胆碱能药物,可能会使健康状况恶化。这些发现强调了定期药物审查和处方策略的重要性,以尽量减少这一弱势群体的抗胆碱能负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anticholinergic Burden and Its Association with Hospitalisation Risk and Causes of Admission in Older Adults with Mild Cognitive Impairment or Dementia.

Background: Older adults with cognitive impairment are vulnerable to the adverse effects of cumulative use of medications with anticholinergic properties. However, existing research on hospitalisation risk in this population remains limited and often lacks focus on the specific causes of admission. This study aims to investigate the role of anticholinergic burden and its association with hospitalisation risk and reasons for admission among older adults with mild cognitive impairment or dementia.

Methods: This retrospective study included older adults with mild cognitive impairment or dementia attending the memory clinic between January to December 2022. Collected data from the electronic medical records includes sociodemographic information, comorbidities, cognitive and functional assessment, neuropsychiatric symptoms, and medication history. Anticholinergic burden was assessed using the Anticholinergic Cognitive Burden (ACB) score. Cox proportional hazard analysis was performed to assess the association between ACB scores and hospitalisation risk. The underlying causes of hospital admissions were compared across the different ACB score groups.

Results: A total of 657 older adults were included in the analysis, with a mean age of 80.66 (SD 7.39) years. Anticholinergic medication use was seen in 35.5%, with a mean ACB score of 0.8 (SD 1.3). Higher ACB scores were associated with nursing home residency, presence of neuropsychiatric symptom, poorer cognitive and physical function, and a greater number of prescribed medications compared to those with no anticholinergic burden. Older adults with ACB scores of 1-2 had an increased risk of hospitalisation (Hazard Ratio(HR)=1.84,95% CI:1.17-2.90) in univariate analysis, but this association was diminished after adjusting for confounders. The most common reasons for hospital admission were pneumonia (5.7%), acute kidney injury (3.8%), delirium (2.6%) and falls (2.6%). Notably, individuals hospitalised for serious adverse cardiovascular events or infected pressure ulcers had significantly higher ACB scores.

Conclusion: One-third of older adults with mild cognitive impairment or dementia use anticholinergic medications, potentially worsening health outcomes. These findings underscore the importance of regular medication review and deprescribing strategies to minimise anticholinergic burden in this vulnerable population.

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来源期刊
Clinical Interventions in Aging
Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-
CiteScore
6.80
自引率
2.80%
发文量
193
审稿时长
6-12 weeks
期刊介绍: Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.
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