The Association of Anticholinergic Drugs and Delirium in Nursing Home Patients With Dementia: Results From the SHELTER Study

被引:9
作者
Oudewortel, Letty [1 ]
van der Roest, Henriette G. [2 ]
Onder, Graziano [3 ,4 ]
Wijnen, Viona J. M. [5 ]
Liperoti, Rosa [3 ,4 ]
Denkinger, Michael [6 ]
Finne-Soveri, Harriet [7 ]
Topinkova, Eva [8 ,9 ]
Henrard, Jean-Claude [10 ]
van Gool, Willem A. [11 ]
机构
[1] Univ Amsterdam, Amsterdam Publ Hlth Res Inst, Dept Gen Practice & Elderly Care Med, Med Ctr, Parnassia Ouderenkliniek Oude Parklaan 149, NL-1901 ZZ Amsterdam, Netherlands
[2] Trimbos Inst, Dept Aging, Netherlands Inst Mental Hlth & Addict, Utrecht, Netherlands
[3] Fdn Policlin Univ A Gemelli IRCCS, Rome, Italy
[4] Univ Cattolica Sacro Cuore, Rome, Italy
[5] Parnassia Grp, Inst Mental Hlth Care, Psychogeriatr Observat Unit, The Hague, Netherlands
[6] Ulm Univ, Geriatr Ctr Ulm Alb Donau, Agaples Bethesda Clin, Ulm, Germany
[7] Natl Inst Hlth & Welf, Dept Welf, Helsinki, Finland
[8] Charles Univ Prague, Fac Med 1, Dept Geriatr, Prague, Czech Republic
[9] Univ South Bohemia, Fac Hlth & Social Sci, Ceske Budejovice, Czech Republic
[10] Versailles St Quentin en Yvelines Univ, Res Unit Hlth Environm Ageing, Paris, France
[11] Univ Amsterdam, Dept Neurol, Amsterdam UMC, Amsterdam, Netherlands
关键词
Delirium; dementia; anticholinergic medications; nursing home patients; LONG-TERM-CARE; ELDERLY-PATIENTS; GERIATRIC SYNDROMES; NEGATIVE OUTCOMES; PHYSICAL FUNCTION; MEDICATIONS; MORTALITY; RISK; POPULATION; FACILITIES;
D O I
10.1016/j.jamda.2021.05.039
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: Drugs with anticholinergic properties are associated with an increased prevalence of delirium, especially in older persons. The aim of this study was to evaluate the association between the use of this class of drugs in nursing home (NH) patients and prevalence of delirium, particularly in people with dementia. Design: Cross-sectional multicenter study. Setting and participants: 3924 nursing home patients of 57 nursing homes in 7 European countries participating in the Services and Health for Elderly in Long TERmcare (SHELTER) project. Methods: Descriptive statistics, calculation of percentage, and multivariable logistic analysis were applied to describe the relationship between anticholinergic drug use and prevalence of delirium in NH patients. The Anticholinergic Risk Scale (ARS) and the Anticholinergic Burden Scale (ACB) were used to calculate the anticholinergic load. Results: 54% of patients with dementia and 60% without dementia received at least 1 anticholinergic drug according to the ACB. The prevalence of delirium was higher in the dementia group (21%) compared with the nondementia group (11%). Overall, anticholinergic burden according to the ACB and ARS was associated with delirium both in patients with and without dementia, with odds ratios ranging from 1.07 [95% confidence interval (CI) 0.94-1.21] to 1.26 (95% CI 1.11-1.44). These associations reached statistical significance only in the group of patients with dementia. Among patients with dementia, delirium prevalence increased only modestly with increasing anticholinergic burden according to the ACB, from 20% (with none or minimal anticholinergic burden) to 25% (with moderate burden) and 27% delirium (with strong burden scores). Conclusions and Implications: The ACB scale is relatively capable to detect anticholinergic side effects, which are positively associated with prevalence of delirium in NH patients. Given the modest nature of this association, strong recommendations are currently not warranted, and more longitudinal studies are needed. (c) 2021 The Authors. Published by Elsevier Inc. on behalf of AMDA -The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
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收藏
页码:2087 / 2092
页数:6
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