Measures of Anticholinergic Drug Exposure, Serum Anticholinergic Activity, and All-cause Postdischarge Mortality in Older Hospitalized Patients with Hip Fractures

被引:85
|
作者
Mangoni, Arduino A. [1 ,2 ]
van Munster, Barbara C. [3 ,4 ]
Woodman, Richard J. [5 ]
de Rooij, Sophia E. [3 ]
机构
[1] Univ Aberdeen, Div Appl Med, Aberdeen AB25 2ZD, Scotland
[2] NHS Grampian, Woodend Hosp, Dept Med Elderly, Aberdeen, Scotland
[3] Univ Amsterdam, Acad Med Ctr, Dept Internal Med, Geriatr Sect, NL-1105 AZ Amsterdam, Netherlands
[4] Gelre Hosp, Dept Geriatr, Apeldoorn, Netherlands
[5] Flinders Univ S Australia, Sch Med, Discipline Gen Practice, Adelaide, SA 5001, Australia
来源
AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY | 2013年 / 21卷 / 08期
关键词
Anticholinergic drug scoring systems; cognitive impairment; delirium; mortality; older patients; serum anticholinergic activity; ELDERLY MEDICAL PATIENTS; SURGICAL REPAIR; BURDEN INDEX; COGNITIVE PERFORMANCE; ACUTE ILLNESS; RISK SCALE; DELIRIUM; PEOPLE; ASSOCIATIONS; SCORE;
D O I
10.1016/j.jagp.2013.01.012
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objectives: To assess possible associations between anticholinergic drug exposure and serum anticholinergic activity (SAA) and their capacities to predict all-cause mortality in older hospitalized patients. Setting: Academic medical center. Participants and Measurements: Data on clinical characteristics, full medication exposure, SAA, and 4 anticholinergic drug scoring systems (ADSSs: Anticholinergic Risk Scale [ARS], Anticholinergic Drug Scale, Anticholinergic Burden scale, and anticholinergic component of the Drug Burden Index) were collected in 71 older hospitalized patients (age 84 +/- 6 years) awaiting surgical repair after hip fractures. Results: The median (range) SAA was 2.8 (1.1-4.9) pmol/mL. Age (rho = 0.25, p = 0.03), Katz Index of Independence in Activities of Daily Living score (rho = 0.39, p = 0.001), in-hospital delirium (rho = 0.29, p = 0.01), preadmission cognitive impairment (rho = 0.31, p = 0.01), and the number of nonanticholinergic drugs (n-NA, rho = -0.27, p = 0.02) were associated with SAA. No significant associations were detected between ADSSs and SAA. Cognitive impairment (beta = 2.1, 95% confidence interval [CI]: 0.7 to 2.5, p = 0.005) and n-NA (beta = -0.3, 95% CI: -0.5 to -0.03, p = 0.03) were independently associated with SAA. Cognitive impairment (hazard ratio [HR]: 6.7, 95% CI: 1.1 to 40.3, p = 0.04) and higher ARS scores (HR: 2.2, 95% CI: 1.2 to 3.7, p = 0.006) independently predicted 3-month mortality whereas in-hospital delirium (HR: 3.6, 95% CI: 1.3 to 10.3, p = 0.02), living at home (HR: 0.2, 95% CI: 0.0 to 0.9, p = 0.03), and length of hospital stay (HR: 1.1, 95% CI: 1.0 to 1.2, p = 0.004) independently predicted 1-year mortality after adjustment for age, gender, and Charlson comorbidity index. Conclusions: Cognitive impairment and n-NA, but not ADSSs, are independently associated with SAA in older hospitalized patients. The ARS score, together with cognitive impairment, in-hospital delirium, place of residence, and length of hospital stay, predicts all-cause mortality in this group.
引用
收藏
页码:785 / 793
页数:9
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