BACKGROUND Polypharmacy is very common in elderly patients and is associated with detrimental outcomes. OBJECTIVE Our objective was to evaluate the associations between a large panel of therapy quality indicators, including explicit lists of potentially inappropriate medications (PIMs; Beers criteria and Screening Tool of Older Persons' potentially inappropriate Prescriptions [STOPP] criteria), the Anticholinergic Cognitive Burden (ACB) score, and the number of drug-drug interactions (DDIs), with respect to mortality, rehospitalization, and physical function decline within 3 months from hospital discharge in a cohort of hospitalized elderly patients. METHODS We studied 2631 individuals aged ≥ 65 years (median age 79.6; males 48.6%) enrolled in the REPOSI registry. The relationships with mortality and rehospitalization were evaluated using Cox regressions, and relationships with functional status change (as percentage variation of Barthel Index [BI]) were evaluated using mixed linear models. RESULTS None of the studied indicators was associated with mortality and rehospitalization. Conversely, only ACB was associated with physical function decline, even after correction for confounders (adjusted mean BI variation of - 7.55%; 95% confidence interval [CI] - 12.37 to - 2.47). The number of medications at discharge, particularly polypharmacy (more than five drugs daily), were the only therapy-related factors associated with mortality (adjusted hazard ratio [aHR] 1.05 [95% CI 1.01-1.10] and 1.70 [95% CI 1.12-2.58], respectively) and rehospitalization (aHR 1.05 [95% CI 1.01-1.08] and 1.31 [95% CI 1.01-1.71], respectively). CONCLUSION Polypharmacy, a very simple measure, outperformed sophisticated PIM and DDI indicators of quality of therapy as a correlate of primary clinical outcomes, whereas ACB was associated with physical function decline. Thus, innovative approaches to the definition and research of PIMs and DDIs are eagerly awaited from the perspective of averaging the quantitative burden and qualitative interaction of drugs.

中文翻译：

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老年住院患者可能不适当的药物、药物相互作用和抗胆碱能负担：与出院后的健康结果是否存在关联？

背景多重用药在老年患者中非常普遍，并且与有害结果相关。目标我们的目标是评估大量治疗质量指标之间的关联，包括潜在不适当药物的明确清单（PIM；Beers 标准和老年人潜在不适当处方筛选工具 [STOPP] 标准）、抗胆碱能认知负担（ ACB) 评分和药物相互作用 (DDI) 的数量，在一组住院老年患者中，与出院后 3 个月内的死亡率、再住院率和身体功能下降有关。方法 我们研究了 2631 名年龄 ≥ 65 岁（中位年龄 79.6 岁；男性 48.6%）在 REPOSI 登记处登记的个体。使用 Cox 回归评估与死亡率和再住院的关系，并使用混合线性模型评估与功能状态变化（作为 Barthel 指数 [BI] 的百分比变化）的关系。结果 所研究的指标均与死亡率和再住院率无关。相反，即使在校正混杂因素后，只有 ACB 与身体功能下降相关（调整后的平均 BI 变异为 - 7.55%；95% 置信区间 [CI] - 12.37 至 - 2.47）。出院时的药物数量，尤其是多种药物（每天超过 5 种药物），是唯一与死亡率相关的治疗相关因素（调整后的风险比 [aHR] 1.05 [95% CI 1.01-1.10] 和 1.70 [95% CI 1.12] -2.58]）和再住院（aHR 1.05 [95% CI 1.01-1.08] 和 1.31 [95% CI 1.01-1.71]，分别）。结论 综合用药是一种非常简单的衡量标准，作为与主要临床结果的相关性，治疗质量的复杂 PIM 和 DDI 指标优于复杂的 PIM 和 DDI 指标，而 ACB 与身体功能下降相关。因此，从平均药物的定量负担和定性相互作用的角度，迫切期待对 PIM 和 DDI 进行定义和研究的创新方法。