Ho Lun Wong, Claire Weaver, Lauren Marsh, Khine Oo Mon, John M. Dapito, Fouad R. Amin, Rahul Chauhan, Amit K. J. Mandal, Constantinos G. Missouris
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Primary outcomes were polypharmacy, defined as prescription of 5 or more regular oral medications, and ACB score.</p>\n </section>\n \n <section>\n \n <h3> Key Results</h3>\n \n <p>Four hundred eleven (411) consecutive subjects were included, mean age 83.8 ± 8.0 years: 40.6% men. There were 38.4% patients who were admitted with falls. Incidence of polypharmacy was 80.8%, (88.0% and 76.3% among those admitted with and without fall, respectively). Incidence of ACB score of 0, 1, 2, ≥ 3 was 38.7%, 20.9%, 14.6%, and 25.8%, respectively. On multivariate analysis, age [odds ratio (OR) = 1.030, 95% CI:1.000 ~ 1.050, <i>P</i> = 0.049], ACB score (OR = 1.150, 95% CI:1.020 ~ 1.290, <i>P</i> = 0.025), polypharmacy (OR = 2.140, 95% CI:1.190 ~ 3.870, <i>P</i> = 0.012), but not Charlson Comorbidity Index (OR = 0.920, 95% CI:0.810 ~ 1.040, <i>P</i> = 0.172) were significantly associated with higher falls rate. Of patients admitted with falls, 29.8% had drug-related orthostatic hypotension, 24.7% had drug-related bradycardia, 37.3% were prescribed centrally acting drugs, and 12.0% were taking inappropriate hypoglycemic agents.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Polypharmacy results in cumulative ACB and both are significantly associated with falls risk in older adults. The presence of polypharmacy and each unit rise in ACB score have a stronger effect of increasing falls risk compared to age and comorbidities.</p>\n </section>\n </div>","PeriodicalId":32862,"journal":{"name":"Aging Medicine","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/13/61/AGM2-6-116.PMC10242266.pdf","citationCount":"3","resultStr":"{\"title\":\"Polypharmacy and cumulative anticholinergic burden in older adults hospitalized with fall\",\"authors\":\"Ho Lun Wong, Claire Weaver, Lauren Marsh, Khine Oo Mon, John M. Dapito, Fouad R. Amin, Rahul Chauhan, Amit K. J. Mandal, Constantinos G. 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引用次数: 3
摘要
多药是一种日益增长的与老年人不良反应相关的现象。我们评估了因跌倒住院的患者累积抗胆碱能负荷(ACB)的潜在混杂效应。方法对年龄≥65岁的未选择急性入院患者进行非干预性前瞻性队列研究。数据来源于电子患者健康记录。对结果进行分析,确定多药发生频率、ACB程度及其与跌倒风险的关系。主要结局是多药,定义为处方5种或更多常规口服药物,以及ACB评分。纳入411例连续受试者,平均年龄83.8±8.0岁,男性占40.6%。38.4%的患者因跌倒入院。多药的发生率为80.8%(住院时伴有跌倒的占88.0%,未伴有跌倒的占76.3%)。ACB评分为0、1、2、≥3的发生率分别为38.7%、20.9%、14.6%、25.8%。多因素分析显示,年龄[比值比(OR) = 1.030, 95% CI:1.000 ~ 1.050, P = 0.049]、ACB评分(OR = 1.150, 95% CI:1.020 ~ 1.290, P = 0.025)、多药治疗(OR = 2.140, 95% CI:1.190 ~ 3.870, P = 0.012)与较高的跌倒率相关,而Charlson合病指数(OR = 0.920, 95% CI:0.810 ~ 1.040, P = 0.172)与较高的跌倒率无关。在因跌倒入院的患者中,29.8%的患者有药物相关性直立性低血压,24.7%的患者有药物相关性心动过缓,37.3%的患者使用中央作用药物,12.0%的患者使用不适当的降糖药。结论多种药物导致累积ACB,两者与老年人跌倒风险显著相关。与年龄和合并症相比,多药的存在和ACB评分每增加一个单位对增加跌倒风险的影响更大。
Polypharmacy and cumulative anticholinergic burden in older adults hospitalized with fall
Introduction
Polypharmacy is a growing phenomenon associated with adverse effects in older adults. We assessed the potential confounding effects of cumulative anticholinergic burden (ACB) in patients who were hospitalized with falls.
Methods
A noninterventional, prospective cohort study of unselected, acute admissions aged ≥ 65 years. Data were derived from electronic patient health records. Results were analyzed to determine the frequency of polypharmacy and degree of ACB and their relationship to falls risk. Primary outcomes were polypharmacy, defined as prescription of 5 or more regular oral medications, and ACB score.
Key Results
Four hundred eleven (411) consecutive subjects were included, mean age 83.8 ± 8.0 years: 40.6% men. There were 38.4% patients who were admitted with falls. Incidence of polypharmacy was 80.8%, (88.0% and 76.3% among those admitted with and without fall, respectively). Incidence of ACB score of 0, 1, 2, ≥ 3 was 38.7%, 20.9%, 14.6%, and 25.8%, respectively. On multivariate analysis, age [odds ratio (OR) = 1.030, 95% CI:1.000 ~ 1.050, P = 0.049], ACB score (OR = 1.150, 95% CI:1.020 ~ 1.290, P = 0.025), polypharmacy (OR = 2.140, 95% CI:1.190 ~ 3.870, P = 0.012), but not Charlson Comorbidity Index (OR = 0.920, 95% CI:0.810 ~ 1.040, P = 0.172) were significantly associated with higher falls rate. Of patients admitted with falls, 29.8% had drug-related orthostatic hypotension, 24.7% had drug-related bradycardia, 37.3% were prescribed centrally acting drugs, and 12.0% were taking inappropriate hypoglycemic agents.
Conclusion
Polypharmacy results in cumulative ACB and both are significantly associated with falls risk in older adults. The presence of polypharmacy and each unit rise in ACB score have a stronger effect of increasing falls risk compared to age and comorbidities.