Abstract：
Investigate the association between anticholinergic (AC) and sedative (SED) drug burden before hospitalization and postdischarge institutionalization (PDI) in community-dwelling older patients acutely admitted to hospital.
A cross-sectional study using data from the Norwegian Patient Registry and the Norwegian Prescription Database. We studied acutely hospitalized community-dwelling patients ≥70 years during 2013 (N = 86 509). Patients acutely admitted to geriatric wards underwent subgroup analyses (n = 1715). We calculated drug burden by the Drug Burden Index (DBI), use of AC/SED drugs, and the number of AC/SED drugs. Piecewise linearity of DBI versus PDI and a knot point (DBI = 2.45) was identified. Statistical analyses included an adjusted multivariable logistic regression model.
In the total population, 45.4% were exposed to at least one AC/SED drug, compared to 52.5% in the geriatric subgroup. AC/SED drugs were significantly associated with PDI. The DBI with odds ratios (ORs) of 1.11 (95% CI 1.07-1.15) for DBI < 2.45 and 1.08 (95% CI 1.04-1.13) for DBI ≥ 2.45. The number of AC/SED drugs with OR of 1.07 (95% CI 1.05-1.09). The AC component of DBI with OR 1.23 and the number of AC drugs with OR 1.13. In the subgroup, ORs were closer to 1 for AC drugs.
The use of AC/SED drugs was highly prevalent in older patients before acute hospital admissions, and significantly associated with PDI. The number, or just using AC/SED drugs, gave similar associations with PDI compared to applying the DBI. Using AC drugs showed higher sensitivity, indicating that to reduce the risk of PDI, a clinical approach could be to reduce the number of AC drugs.
A cross-sectional study using data from the Norwegian Patient Registry and the Norwegian Prescription Database. We studied acutely hospitalized community-dwelling patients ≥70 years during 2013 (N = 86 509). Patients acutely admitted to geriatric wards underwent subgroup analyses (n = 1715). We calculated drug burden by the Drug Burden Index (DBI), use of AC/SED drugs, and the number of AC/SED drugs. Piecewise linearity of DBI versus PDI and a knot point (DBI = 2.45) was identified. Statistical analyses included an adjusted multivariable logistic regression model.
In the total population, 45.4% were exposed to at least one AC/SED drug, compared to 52.5% in the geriatric subgroup. AC/SED drugs were significantly associated with PDI. The DBI with odds ratios (ORs) of 1.11 (95% CI 1.07-1.15) for DBI < 2.45 and 1.08 (95% CI 1.04-1.13) for DBI ≥ 2.45. The number of AC/SED drugs with OR of 1.07 (95% CI 1.05-1.09). The AC component of DBI with OR 1.23 and the number of AC drugs with OR 1.13. In the subgroup, ORs were closer to 1 for AC drugs.
The use of AC/SED drugs was highly prevalent in older patients before acute hospital admissions, and significantly associated with PDI. The number, or just using AC/SED drugs, gave similar associations with PDI compared to applying the DBI. Using AC drugs showed higher sensitivity, indicating that to reduce the risk of PDI, a clinical approach could be to reduce the number of AC drugs.
摘要：
目的：研究社区住院老年急性住院患者住院前和出院后（PDI）抗胆碱能（AC）和镇静剂（SED）药物负担之间的关系。
方法：采用挪威患者登记处和挪威处方数据库数据的横断面研究。我们研究了2013年≥70岁的社区住院患者(N=86,509)。急性进入老年病房的患者进行了亚组分析（n=1,715）。我们通过药物负担指数(DBI)计算药物负担，使用AC/SED药物，以及AC/SED药物的数量。确定了DBI与PDI的分段线性和节点(DBI=2.45)。统计分析包括调整后的多变量逻辑回归模型。
结果：在总人口中，45.4%暴露于至少一种AC/SED药物，与老年亚组的52.5%相比。AC/SED药物与PDI显著相关。DBI<2.45时，Odds比率(ORs)为1.11(95%CI1.07-1.15)，DBI≥2.45时，Odds比率为1.08(95%CI1.04-1.13)。OR为1.07的AC/SED药物数量(95%CI1.05-1.09)。DBI的AC组分OR为1.23,AC药物的数目OR为1.13。在子组中，AC药物的ORs接近1。
结论：老年患者在急性入院前使用AC/SED药物非常普遍，并与PDI显著相关。数字,或者只是使用AC/SED药物，与应用DBI相比，给出了与PDI相似的关联。使用AC药物显示出更高的敏感性，这表明为了降低PDI的风险，临床方法可能是减少AC药物的数量.
方法：采用挪威患者登记处和挪威处方数据库数据的横断面研究。我们研究了2013年≥70岁的社区住院患者(N=86,509)。急性进入老年病房的患者进行了亚组分析（n=1,715）。我们通过药物负担指数(DBI)计算药物负担，使用AC/SED药物，以及AC/SED药物的数量。确定了DBI与PDI的分段线性和节点(DBI=2.45)。统计分析包括调整后的多变量逻辑回归模型。
结果：在总人口中，45.4%暴露于至少一种AC/SED药物，与老年亚组的52.5%相比。AC/SED药物与PDI显著相关。DBI<2.45时，Odds比率(ORs)为1.11(95%CI1.07-1.15)，DBI≥2.45时，Odds比率为1.08(95%CI1.04-1.13)。OR为1.07的AC/SED药物数量(95%CI1.05-1.09)。DBI的AC组分OR为1.23,AC药物的数目OR为1.13。在子组中，AC药物的ORs接近1。
结论：老年患者在急性入院前使用AC/SED药物非常普遍，并与PDI显著相关。数字,或者只是使用AC/SED药物，与应用DBI相比，给出了与PDI相似的关联。使用AC药物显示出更高的敏感性，这表明为了降低PDI的风险，临床方法可能是减少AC药物的数量.
