Amanda J. Cross , Emanuele R. Villani , Agathe D. Jadczak , Kaisu Pitkälä , Shota Hamada , Meng Zhao , Marta Gutiérrez-Valencia , Ulla Aalto , Laura A. Dowd , Li Li , Shin J. Liau , Rosa Liperoti , Nicolás Martínez-Velilla , Choon Ean Ooi , Graziano Onder , Kate Petrie , Hanna M. Roitto , Victoria Roncal-Belzunce , Riitta Saarela , Nobuo Sakata , J. Simon Bell
{"title":"有认知障碍和体弱的住院者和无认知障碍和体弱的住院者使用强效抗胆碱能药物的普遍程度：对 12 个亚太和欧洲国家 106 家养老院的分析","authors":"Amanda J. Cross , Emanuele R. Villani , Agathe D. Jadczak , Kaisu Pitkälä , Shota Hamada , Meng Zhao , Marta Gutiérrez-Valencia , Ulla Aalto , Laura A. Dowd , Li Li , Shin J. Liau , Rosa Liperoti , Nicolás Martínez-Velilla , Choon Ean Ooi , Graziano Onder , Kate Petrie , Hanna M. Roitto , Victoria Roncal-Belzunce , Riitta Saarela , Nobuo Sakata , J. Simon Bell","doi":"10.1016/j.archger.2024.105636","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty.</p></div><div><h3>Methods</h3><p>Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0–2 (non-frail), 3–6 (frail) and 7–14 (most-frail). Data were analyzed using descriptive statistics.</p></div><div><h3>Results</h3><p>Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %).</p></div><div><h3>Conclusions</h3><p>One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.</p></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"128 ","pages":"Article 105636"},"PeriodicalIF":3.5000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167494324003121/pdfft?md5=4af0421a68b14f894d007038945432d7&pid=1-s2.0-S0167494324003121-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Prevalence of strong anticholinergic use in residents with and without cognitive impairment and frailty: Analysis from 106 nursing homes in 12 Asia-Pacific and European countries\",\"authors\":\"Amanda J. Cross , Emanuele R. Villani , Agathe D. Jadczak , Kaisu Pitkälä , Shota Hamada , Meng Zhao , Marta Gutiérrez-Valencia , Ulla Aalto , Laura A. Dowd , Li Li , Shin J. Liau , Rosa Liperoti , Nicolás Martínez-Velilla , Choon Ean Ooi , Graziano Onder , Kate Petrie , Hanna M. Roitto , Victoria Roncal-Belzunce , Riitta Saarela , Nobuo Sakata , J. Simon Bell\",\"doi\":\"10.1016/j.archger.2024.105636\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty.</p></div><div><h3>Methods</h3><p>Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0–2 (non-frail), 3–6 (frail) and 7–14 (most-frail). Data were analyzed using descriptive statistics.</p></div><div><h3>Results</h3><p>Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %).</p></div><div><h3>Conclusions</h3><p>One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.</p></div>\",\"PeriodicalId\":8306,\"journal\":{\"name\":\"Archives of gerontology and geriatrics\",\"volume\":\"128 \",\"pages\":\"Article 105636\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2024-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0167494324003121/pdfft?md5=4af0421a68b14f894d007038945432d7&pid=1-s2.0-S0167494324003121-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of gerontology and geriatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0167494324003121\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of gerontology and geriatrics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0167494324003121","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
Prevalence of strong anticholinergic use in residents with and without cognitive impairment and frailty: Analysis from 106 nursing homes in 12 Asia-Pacific and European countries
Purpose
There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty.
Methods
Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0–2 (non-frail), 3–6 (frail) and 7–14 (most-frail). Data were analyzed using descriptive statistics.
Results
Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %).
Conclusions
One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.
期刊介绍：
Archives of Gerontology and Geriatrics provides a medium for the publication of papers from the fields of experimental gerontology and clinical and social geriatrics. The principal aim of the journal is to facilitate the exchange of information between specialists in these three fields of gerontological research. Experimental papers dealing with the basic mechanisms of aging at molecular, cellular, tissue or organ levels will be published.
Clinical papers will be accepted if they provide sufficiently new information or are of fundamental importance for the knowledge of human aging. Purely descriptive clinical papers will be accepted only if the results permit further interpretation. Papers dealing with anti-aging pharmacological preparations in humans are welcome. Papers on the social aspects of geriatrics will be accepted if they are of general interest regarding the epidemiology of aging and the efficiency and working methods of the social organizations for the health care of the elderly.
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