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Abstract：
BACKGROUND: We aimed to evaluate the association of anticholinergic burden and chronic polypharmacy with the incidence of functional decline and all-cause mortality, and to determine the difference between anticholinergic burden and chronic polypharmacy among Korean older people.
METHODS: This nationwide cohort study included 42,132 older people aged ≥ 65 years who underwent Korean National Health Insurance Service health examinations from 2007 to 2008. Odds ratios (ORs) and 95% confidence intervals (CIs) for abnormal Timed Up and Go (TUG) test results were assessed using multivariate logistic regression analyses. Hazard ratios (HRs) and 95% CIs for all-cause mortality until the end of 2015 were estimated using multivariable Cox proportional hazards regression analysis.
RESULTS: Of the participants, 37.19% had abnormal TUG test results, and 7.66% of those died during the 5.7-year mean follow-up. The abnormal TUG test results OR increased by 27% among individuals with Korean Anticholinergic Burden Scale (KABS) scores ≥ 3 (OR 1.27, 95% CI 1.02-1.58) compared to those with KABS scores of 0. The HRs for all-cause mortality increased for individuals with higher KABS scores (P for trend < 0.001) or chronic polypharmacy (P for trend < 0.001) compared to those for individuals without these conditions. The combination of a higher KABS or chronic polypharmacy and abnormal TUG test results increased the risk of all-cause mortality (All P for trend < 0.001).
CONCLUSIONS: Anticholinergic drug burden shows a better association with functional decline than chronic polypharmacy, and the use of medications and functional decline may be important risk factors for all-cause mortality among older people.
METHODS: This nationwide cohort study included 42,132 older people aged ≥ 65 years who underwent Korean National Health Insurance Service health examinations from 2007 to 2008. Odds ratios (ORs) and 95% confidence intervals (CIs) for abnormal Timed Up and Go (TUG) test results were assessed using multivariate logistic regression analyses. Hazard ratios (HRs) and 95% CIs for all-cause mortality until the end of 2015 were estimated using multivariable Cox proportional hazards regression analysis.
RESULTS: Of the participants, 37.19% had abnormal TUG test results, and 7.66% of those died during the 5.7-year mean follow-up. The abnormal TUG test results OR increased by 27% among individuals with Korean Anticholinergic Burden Scale (KABS) scores ≥ 3 (OR 1.27, 95% CI 1.02-1.58) compared to those with KABS scores of 0. The HRs for all-cause mortality increased for individuals with higher KABS scores (P for trend < 0.001) or chronic polypharmacy (P for trend < 0.001) compared to those for individuals without these conditions. The combination of a higher KABS or chronic polypharmacy and abnormal TUG test results increased the risk of all-cause mortality (All P for trend < 0.001).
CONCLUSIONS: Anticholinergic drug burden shows a better association with functional decline than chronic polypharmacy, and the use of medications and functional decline may be important risk factors for all-cause mortality among older people.
摘要：
背景：我们旨在评估抗胆碱能负担和慢性多药疗法与功能减退和全因死亡率的发生率的关系，并确定韩国老年人抗胆碱能负担和慢性多药之间的差异。
方法：这项全国性的队列研究包括42,132名年龄≥65岁的老年人，他们从2007年到2008年接受了韩国国民健康保险服务健康检查。使用多变量逻辑回归分析评估异常定时和定时（TUG）测试结果的赔率（OR）和95％置信区间（CI）。使用多变量Cox比例风险回归分析估计2015年底前全因死亡率的危险比(HR)和95%CI。
结果：在参与者中，37.19%的TUG检测结果异常，7.66%的患者在5.7年平均随访期间死亡。韩国抗胆碱能负担量表（KABS）评分≥3（OR1.27，95％CI1.02-1.58）的个体与KABS评分为0的个体相比，异常TUG测试结果OR增加了27％。与没有这些疾病的个体相比，具有较高KABS评分（趋势<0.001）或慢性多重用药（趋势<0.001）的个体的全因死亡率的HR增加。较高的KABS或慢性多重用药和异常的TUG测试结果的组合增加了全因死亡的风险（所有趋势P<0.001）。
结论：抗胆碱能药物负荷显示与功能减退的相关性比慢性多药更好，药物的使用和功能下降可能是老年人全因死亡的重要危险因素。
方法：这项全国性的队列研究包括42,132名年龄≥65岁的老年人，他们从2007年到2008年接受了韩国国民健康保险服务健康检查。使用多变量逻辑回归分析评估异常定时和定时（TUG）测试结果的赔率（OR）和95％置信区间（CI）。使用多变量Cox比例风险回归分析估计2015年底前全因死亡率的危险比(HR)和95%CI。
结果：在参与者中，37.19%的TUG检测结果异常，7.66%的患者在5.7年平均随访期间死亡。韩国抗胆碱能负担量表（KABS）评分≥3（OR1.27，95％CI1.02-1.58）的个体与KABS评分为0的个体相比，异常TUG测试结果OR增加了27％。与没有这些疾病的个体相比，具有较高KABS评分（趋势<0.001）或慢性多重用药（趋势<0.001）的个体的全因死亡率的HR增加。较高的KABS或慢性多重用药和异常的TUG测试结果的组合增加了全因死亡的风险（所有趋势P<0.001）。
结论：抗胆碱能药物负荷显示与功能减退的相关性比慢性多药更好，药物的使用和功能下降可能是老年人全因死亡的重要危险因素。
