| Objective: The anticholinergic burden of elderly patients was evaluated by Beers standard and anticholinergic burden score(ACB score).The use of anticholinergic drugs and anticholinergic cognitive burden of hospitalized patients aged 65 and above were studied in order to improve the safety and rationality of anticholinergic use in the elderly.Methods:A total of 859 elderly inpatients(437 males and 422 females)in a third-class hospital in Qingdao from January 2019 to March 2019 were divided into cognitive impairment group(n=78)and non-cognitive impairment group(n=781).The prescriptions of anticholinergic drugs for all patients during hospitalization were collected,including the name,type,frequency and duration of anticholinergic drugs,and the drugs were classified according to the anticholinergic burden scale(ACB).The drugs were divided into three grades: mild(1),moderate(2)and severe(3).The scoring system was as follows: drugs without anticholinergic effects were given 0 points;drugs with possible anticholinergic effects were given 1 score;pairs of anticholinergic drugs clearly related to clinical cognitive impairment were given 2 or 3 points.The total anticholinergic burden score of the drug was calculated from the daily mean of ACB score.The formula is as follows: when the daily average ACB score is 0-0.49,the total anticholinergic burden score is 0 when the ACB score is 0.50-1.49,the total anticholinergic burden score is 1 when the anticholinergic score is 0.50-1.49,the total anticholinergic burden score is 2 when the anticholinergic score is 1.50-2.49,and the total anticholinergic burden score is ≥ 3 when the anticholinergic score is greater than 2.5.The daily average ACB score of all patients was calculated,and the conversion into the corresponding total anticholinergic burden score,the total anticholinergic cognitive burden scale score ≥ 3 was considered to be clinically related.The general data,duration and type of medication,serum cystatin C,serum cholinesterase,hospitalization days,hospitalization times,western medicine expenses and hospitalization diagnosis were compared between the cognitive impairment group and the non-cognitive impairment group.According to the use of Excel2016 for collation,using SPSS24.0 software for statistical analysis,measurement data are expressed by ?x±s.T-test was used to compare the two groups of measurement data with normal distribution,the rate of counting data of the two groups was expressed,and 2-test was used for comparison.It was statistically significant by p<0.05.Linear regression and logistic regression were used to analyze the relationship between anticholinergic burden and related factors.Results:The total score of anticholinergic cognitive burden in 12.9 percent of patients aged 65 and over was ≥ 3.Thirty-three kinds of anticholinergic drugs are used,of which cardiovascular disease drugs are the most frequently used,and most of these drugs belong to ACB class 1 drugs.Serotonin inhibitors are the most frequently used class 3 drugs.The incidence of clinical related anticholinergic burden was 32 percent in the cognitive impairment group and 11 percent in the non-cognitive impairment group.There was a significant difference between the two groups.The MMSE score was significantly correlated with the anticholinergic cognitive burden.Univariate linear regression analysis showed that there was a significant positive correlation between ACB score and the type of medication,the duration of medication,the days of hospitalization,the number of hospitalization and the cost of western medicine,but not with sex and age.Multiple Logistic regression analysis showed that the number of drugs used was positively correlated with anticholinergic burden.Conclusion:Anticholinergic drugs are frequently used in elderly patients,and there are cumulative effects and cascade reactions of anticholinergic drugs.Patients with cognitive impairment are more likely to be exposed to high anticholinergic drugs than those without cognitive impairment.There is a significant correlation between the degree of cognitive impairment and cumulative anticholinergic burden.Severe cognitive impairment leads to an increased risk of clinically related anticholinergic cognitive burden.When the total burden score of anticholinergic drugs used by patients is greater than or equal to 3,clinicians should combine the Beers standard and the patient’s condition,switch to other drugs with ACB scores less than 3 or drugs with lower anticholinergic activity,and reduce the total anticholinergic score to less than 3 to reduce the anticholinergic burden. |
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