Low-Income Older Adults' Vulnerability to Anticholinergic Medication-Associated Frailty.

Autor: Sargent L; School of Nursing, Virginia Commonwealth University, 1100 E Leigh St., Richmond, VA, 23298, USA. lsargent@vcu.edu.; Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA. lsargent@vcu.edu.; Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA. lsargent@vcu.edu., Zimmerman KM; Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA.; Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA., Mohammed A; Department of Pharmacy Practice, College of Pharmacy, Qassim University, 51452, Buraydah, Saudi Arabia., Barrett MJ; Department of Neurology, Virginia Commonwealth University, Richmond, VA, 23298, USA., Nawaz H; Department of Neurology, Virginia Commonwealth University, Richmond, VA, 23298, USA., Wyman-Chick K; HealthPartners Neuroscience Center, St. Paul, MN, 55130, USA., Mackiewicz M; Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA.; Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA., Roman Y; Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA.; Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA., Slattum P; Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA.; Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA.; Virginia Center on Aging, Virginia Commonwealth University, 900 E Leigh St, Richmond, VA, 23298, USA., Russell S; School of Nursing, Virginia Commonwealth University, 1100 E Leigh St., Richmond, VA, 23298, USA., Dixon DL; Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA., Lageman SK; Department of Neurology, Virginia Commonwealth University, Richmond, VA, 23298, USA., Hobgood S; School of Medicine, Department of Geriatrics, Virginia Commonwealth University, 1101 E. Marshall St., Richmond, VA, 23298, USA., Thacker LR; School of Medicine, Department of Biostatistics, Virginia Commonwealth University, 830 East Main Street, Richmond, VA, 23298, USA., Price ET; Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA.; Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA.; Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA.
Jazyk: angličtina
Zdroj: Drugs & aging [Drugs Aging] 2023 Dec; Vol. 40 (12), pp. 1123-1131. Date of Electronic Publication: 2023 Oct 19.
DOI: 10.1007/s40266-023-01069-7
Abstrakt: Background: A growing body of research supports the negative impact of anticholinergic drug burden on physical frailty. However, prior research has been limited to homogeneous white European populations, and few studies have evaluated how anticholinergic burden tools compare in their measurement function and reliability with minority community-dwelling adult populations. This study investigated the association between anticholinergic drug exposure and frailty by conducting a sensitivity analysis using multiple anticholinergic burden tools in a diverse cohort.
Methods: A comprehensive psychometric approach was used to assess the performance of five clinical Anticholinergic Burden Tools: Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), average daily dose, total standardized daily doses (TSDD), and Cumulative Anticholinergic Burden scale (CAB). Spearman correlation matrix and intraclass correlation coefficients (ICC) were used to determine the association among the variables. Ordinal logistic regression is used to evaluate the anticholinergic burden measured by each scale to determine the prediction of frailty. Model performance is determined by the area under the curve (AUC).
Results: The cohort included 80 individuals (mean age 69 years; 55.7% female, 71% African American). All anticholinergic burden tools were highly correlated (p < 0.001), ICC3 0.66 (p < 0.001, 95% confidence interval (CI) 0.53-0.73). Among individuals prescribed anticholinergics, 33% were robust, 44% were prefrail, and 23% were frail. All five tools predicted prefrail and frail status (p < 0.05) with low model misclassification rates for frail individuals (AUC range 0.78-0.85).
Conclusion: Anticholinergic burden tools evaluated in this cohort of low-income African American older adults were highly correlated and predicted prefrail and frail status. Findings indicate that clinicians can select the appropriate instrument for the clinic setting and research question while maintaining confidence that all five tools will produce reliable results. Future anticholinergic research is needed to unravel the association between interventions such as deprescribing on incident frailty in longitudinal data.
(© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Databáze: MEDLINE
Externí odkaz: