Neziha ERKEN, Esra ATEŞ BULUT, Süleyman Emre KOÇYİĞİT, Ahmet Turan IŞIK

Antikolinerjik ilaç yükü ve ilaç sayısının yaşlı hastalarda beslenme durumuna etkisi

Amaç: Malnutrisyon yaşlı bireylerde önemli bir morbidite ve mortalite nedenidir. Bu çalışmada geriatrik sendromlardan malnutrisyonun, kolinerjik yük ve polifarmasi ile ilişkisini incelemek amaçlandı. Gereç ve Yöntem: Çalışmaya 2016-2018 yılları arasında geriatri kliniğine başvuran 1287 hasta dâhil edildi. Hastaların demografik özellikleri, sistemik hastalıkları ve ilaçları kaydedildi. Nutrisyonel durum, Mini Nutrisyonel Değerlendirme Testi-Kısa Form (MNA-SF) ile değerlendirildi. Buna göre hastalar; malnutrisyon, malnutrisyon riski ve normal olarak üç gruba ayrıldı. Polifarmasi, aynı anda dörtten fazla ilaç kullanımı olarak kabul edildi. Antikolinerjik yük, İlaç Yükü İndeksi (İYİ) kullanılarak hesaplandı ve hastaların nutrisyonel durumuyla polifarmasi ve İYİ skoru arasındaki ilişki değerlendirildi. Bulgular: Hastaların yaş ortalaması 76,49±7,35 ve %65,6’si kadındı. Hastaların %8,6’sında malnutrisyon, %31,0’inde malnutrisyon-riski olduğu görüldü. Nutrisyon grupları arasında yaş, Charlson Komorbidite İndeksi, polifarmasi ve İYİ skorları anlamlı olarak farklıydı (p<0,05). Yapılan regresyon analizinde hem İYİ skorunun hem de ilaç sayısının, MNA-SF ile negatif ilişkili olduğu ve İYİ skorunun MNA-SF üzerinde etkisinin daha fazla olduğu görüldü (p<0,05). Sonuç: Polifarmasi ve antikolinerjik yük nutrisyonel durumla yakından ilişkilidir. Geriatri pratiğinde malnutrisyon ve malnutrisyon riski olan bireylerde kullanılan ilaçlar özellikle gözden geçirilmeli ve bu açıdan gerekli müdahaleler yapılmalıdır.

Anahtar Kelimeler:

malnütrisyon, polifarmasi, yaşlı, ilaç etkileri, kolinerjik antagonistler

The effect of anticholinergic drug burden and number of drugs to nutritional status in older patients

Objective: Malnutrition is an important cause of morbidity and mortality in older adults. In this study, it was aimed to investigate the relationship between malnutrition, a geriatric syndrome, and anticholinergic load as well as polypharmacy. Materials and Methods: This study included 1287 patients who applied to the geriatrics clinic between 2016 and 2018. Demographic features, comorbidities and drugs of the patients were recorded. Nutritional status was evaluated with the Mini Nutritional Assessment-Short Form (MNA-SF). Accordingly, patients were divided into three groups in terms of nutritional status: malnutrition, risk of malnutrition and normal. The groups were compared according to polypharmacy. Anticholinergic load was calculated using the Drug Burden Index and the risk was compared between three groups. Results: The mean age of the patients was 76.49 ± 7.35 and 65.6% of patients were women. According to the nutritional status, 8.6%, 31.0% and 60.4% were malnutrition, malnutrition-risk and normal nutritional group, respectively. Polypharmacy was accepted as concomittant use of more than four drugs. Age, Charlson Comorbidity Index, polypharmacy and DBI score were significantly different among nutritional groups (p <0.05). In the regression analysis, it was found that both DBI score and the number of drugs had a significant negative effect on the MNA-SF score, and the DBI score had a greater impact on the MNA-SF (p <0.05). Conclusion: Polypharmacy and anticholinergic load are closely related to nutritional status in older adults. In geriatric practice, drug profiles should be evaluated precisely in the patients who have malnutrition or risk of malnutrition, and the required interventions should be implicated.

Keywords:

malnutrition, polypharmacy, elderly, drug effects, cholinergic antagonists,

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