PDF(Pubmed)
Abstract：
(1) Background: Anticholinergic and sedative drugs (ASDs) contribute to negative health outcomes, especially in the frail population. In this study, we aimed to assess whether frailty increases with anticholinergic burden and to evaluate the effects of medication reviews (MRs) on ASD regimens among patients attending an acute care for the elderly (ACE) unit. (2) Methods: A cohort study was conducted between June 2019 and October 2020 with 150 consecutive patients admitted to our ACE unit. Demographic, clinical, and pharmacological data were assessed. Frailty score was determined using the Frail-VIG index (FI-VIG), and ASD burden was quantified using the drug burden index (DBI). In addition, the MR was performed using the patient-centered prescription (PCP) model. We used a paired T-test to compare the DBI pre- and post-MR and univariate and multivariate regression to identify the factors associated with frailty. (3) Results: Overall, 85.6% (n = 128) of participants showed some degree of frailty (FI-VIG > 0.20) and 84% (n = 126) of patients received treatment with ASDs upon admission (pre-MR). As the degree of frailty increased, so did the DBI (p < 0.001). After the implementation of the MR through the application of the PCP model, a reduction in the DBI was noted (1.06 ± 0.8 versus 0.95 ± 0.7) (p < 0.001). After adjusting for covariates, the association between frailty and the DBI was apparent (OR: 11.42, 95% (CI: 2.77-47.15)). (4) Conclusions: A higher DBI was positively associated with frailty. The DBI decreased significantly in frail patients after a personalized MR. Thus, MRs focusing on ASDs are crucial for frail older patients.
摘要：
（1）背景：抗胆碱能和镇静药物（ASD）有助于负面的健康结果，尤其是在脆弱的人群中。在这项研究中,我们的目的是评估衰弱是否随着抗胆碱能负担的增加而增加,并评估老年急性护理(ACE)病房患者的药物综述(MRs)对ASD方案的影响.（2）方法：2019年6月至2020年10月进行了一项队列研究，纳入了我们ACE单元的150名连续患者。人口统计,临床,和药理学数据进行了评估。使用脆弱-VIG指数（FI-VIG）确定虚弱评分，使用药物负担指数（DBI）量化ASD负担。此外,使用以患者为中心的处方(PCP)模型进行MR检查.我们使用配对T检验来比较MR前后的DBI以及单变量和多变量回归，以确定与虚弱相关的因素。（3）结果：总体上，85.6％（n=128）的参与者表现出一定程度的虚弱（FI-VIG>0.20），84％（n=126）的患者在入院时（MR前）接受了ASD治疗。随着虚弱程度的增加，DBI也是如此（p<0.001）。在通过PCP模型的应用实现MR之后，DBI减少(1.06±0.8对0.95±0.7)(p<0.001)。在调整协变量后，虚弱与DBI之间的关联很明显(OR:11.42,95%(CI:2.77-47.15)).(4)结论:DBI增高与虚弱呈正相关。个性化MR后，虚弱患者的DBI显着降低。因此，MR专注于ASD对于虚弱的老年患者至关重要。
