노인 입원 환자의 항콜린 부담 점수와 섬망 발생 연관성 분석

Abstract

Background : Delirium is a common condition among older adults, negatively impacting quality of life, prolonging hospital stays, and increasing mortality rates. The use of anticholinergic medications is a significant risk factor for delirium. The Korean Anticholinergic Burden Scales (KABS) allow for the quantification of anticholinergic burden, including medications available in South Korea. This study aimed to evaluate the relationship between pre-admission anticholinergic burden scores and the occurrence of delirium in hospitalized older adults. Methods : We analyzed data from 452 hospitalized patients aged 65 and older who underwent comprehensive geriatric assessments at Seoul National University Bundang Hospital from 2021 to 2023. Delirium was identified using diagnosis codes psychiatric referrals, medication administration records and nursing documentation. We compared KABS scores between patients with and without delirium. Multivariable logistic regression was conducted, adjusting for age, sex, Charlson’s comorbidity index, delirium risk, dementia, polypharmacy, peripheral vascular disease, and renal disease. Results : Delirium was diagnosed in 76 patients (16.8%). The mean KABS score was significantly higher in the delirium group (3.4±2.9) compared to the non-delirium group (2.2±2.4, p<0.01). Antipsychotic medication use was more prevalent in the delirium group (42.1% vs 25.5%, p<0.01). Patients with KABS scores of 3 or higher had a 2.29-fold increased risk of developing delirium (adjusted OR=2.29, 95% CI=1.16–4.53). Conclusion : This study demonstrated that higher KABS scores are significantly associated with an increased risk of delirium in older hospitalized patients. Identifying patients with high anticholinergic burden scores prior to admission may help prevent the onset of delirium during hospitalization.