Upotreba lijekova s antikolinergičkim i sedativnim učinkom: presječno istraživanje u domovima za starije i nemoćne osobe

master's thesis

• Title (english): The use of medications with anticholinergic and sedative effects: a cross-sectional study in nursing homes
• Author: Lucia Bačelić
• Mentor: Maja Ortner Hadžiabdić (mentor)
• Committee member: Maja Ortner Hadžiabdić (predsjednik povjerenstva)
• Committee member: Petra Turčić (član povjerenstva)
• Committee member: Miranda Sertić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2024, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

S obzirom na rastući broj dokaza o rizicima povezanih s primjenom lijekova s antikolinergičkim i sedativnim učincima
kod osoba starije životne dobi, cilj ovog istraživanja bio je utvrditi, korištenjem DBI skale, prevalenciju izloženosti DBI
lijekovima te istražiti povezanost njihove primjene s karakteristikama ispitanika i neželjenim zdravstvenim ishodima
među korisnicima domova za starije i nemoćne u Republici Hrvatskoj.
Presječno istraživanje provedeno je u domovima za starije osobe u tri hrvatske regije između kolovoza i studenog 2022.
godine. U istraživanje je bilo uključeno 225 ispitanika u dobi od 65 i više godina. Podaci su prikupljeni pomoću
standardiziranog interRAI-LTCF upitnika za sveobuhvatnu gerijatrijsku procjenu. Mjere ishoda uključivale su
(ne)ovisnost u obavljanju svakodnevnih aktivnosti (ADLs), skalu kognitivnih sposobnosti (CPS), kliničku skalu krhkosti
(CFS), prisutnost simptoma depresije te broj padova i hospitalizacija. Izloženost lijekovima s antikolinergičkim i
sedativnim učincima izračunata je pomoću DBI (engl. Drug Burden Index) skale, internacionalno validirane mjere za
procjenu opterećenja antikolinergicima i sedativima.
Medijan dobi ispitanika iznosio je 83 (IQR 79-86) godine. Prevalencija izloženosti DBI lijekovima iznosila je 77% te je
bila značajno viša među ispitanicima koji su bili izloženi politerapiji (87%) i prekomjernoj politerapiji (95%) te
ispitanicima sa simptomima depresije (88%). Izloženost DBI lijekovima bila je značajno povezana s lošijim rezultatima
na ADL skali (p=0,036) te većom krhkosti ispitanika (p=0,009). Najupotrebljivaniji DBI lijekovi bili su diazepam (29%
ispitanika), tramadol (29%), zolpidem (18%) i alprazolam (16%).
Uočena je visoka prevalencija izloženosti lijekovima s antikolinergičkim i/ili sedativnim učinkom među korisnicima
domova za starije. Korisnici izloženi DBI lijekovima bili su značajno slabijih funkcionalnih sposobnosti. Ova saznanja
potvrđuju valjanost DBI skale kao jednog od alata za prepoznavanje osoba starije životne dobi pod povećanim rizikom
od funkcionalnog oštećenja te ukazuju na potrebu za unapređenjem upravljanja terapijom korisnika domova za starije
osobe. Visoka prevalencija upotrebe benzodiazepina, „Z lijekova“ i tramadola ukazuje na potrebu za depreskripcijom.

Abstract (english)

Given the increasing evidence of risks of anticholinergic and sedative medications use in older people, the aim of this
study was to determine, using the DBI scale, prevalence of exposure to DBI medications and explore the association of
DBI medications use with participant's characteristics and adverse health outcomes among Croatian nursing homes
residents.
A cross-sectional study was conducted in nursing homes in three Croatian regions between August and November 2022.
The study included 225 participants aged 65 years and older. Data was collected using a standardized interRAI-LTCF
questionnaire for comprehensive geriatric assessment. Outcome measures included (in)dependence in activities of daily
living (ADLs), cognitive performance scale (CPS), clinical frailty scale (CFS), presence of depressive symptoms and
number of falls and hospitalizations. Exposure to anticholinergic and sedative medications was calculated using the
Drug Burden Index (DBI), internationally validated tool that measures the burden of anticholinergic and sedative
medications.
Median age of participants was 83 (IQR 79-86) years. Prevalence of exposure to DBI medications was 77% and it was
significantly higher among participants exposed to polypharmacy (87%) and hyperpolypharmacy (95%) and participants
with symptoms of depression. Exposure to DBI medications was significantly associated with poorer performance on
ADL scale (p=0,036) and higher frailty among participants (p=0,009). The most frequently used DBI medications were
diazepam (29% of participants), tramadol (29%), zolpidem (18%) and alprazolam (16%).
High prevalence of exposure to drugs with anticholinergic and/or sedative effects was observed among nursing home
residents in Croatia. Residents exposed to DBI drugs had significantly poorer functional performance. These findings
confirm the validity of DBI as the tool for identifying older adults at higher risk of functional impairment and indicate
the need for improving pharmacotherapy management of nursing home residents. High use of benzodiazepines, „Zdrugs“ and tramadol suggests there are opportunities for deprescribing.

• Keywords: antikolinergici; sedativi; starija životna dob; Drug burden index; DBI
• Keywords (english): anticholinergics; sedatives; older adults; Drug burden index; DBI
• Language: croatian
• URN:NBN: urn:nbn:hr:163:377213
• Study programme: Title: Pharmacy - integrated undergraduate and graduate - university study; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: sveučilišni magistar farmacije (sveučilišni magistar farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Embargoed access; Embargo expiration date: 2026-03-29
• Created on: 2024-05-08 09:07:55