JAMDA
Volume 10, Issue 4 , Pages 252-257, May 2009

A Preliminary Study of Anticholinergic Burden and Relationship to a Quality of Life Indicator, Engagement in Activities, in Nursing Home Residents With Dementia

  • Ann Kolanowski, PhD, RN

      Affiliations

    • School of Nursing, Pennsylvania State University, University Park, PA
    • Corresponding Author InformationAddress correspondence to Ann Kolanowski, PhD, RN, School of Nursing, Pennsylvania State University, University Park, PA 16802.
    • ,
  • Donna M. Fick, PhD, GCNS-BC

      Affiliations

    • School of Nursing, Pennsylvania State University, University Park, PA
    • ,
  • Judy Campbell, MSN, ARNP

      Affiliations

    • College of Nursing, University of Florida, Gainesville, FL
    • ,
  • Mark Litaker, PhD

      Affiliations

    • School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Malaz Boustani, MD, MPH

      Affiliations

    • Indiana University Center for Aging Research, and Regenstrief Institute, Inc, Indianapolis, IN

published online 12 January 2009.

Objectives

(1) To describe the anticholinergic burden experienced by nursing home residents with dementia using the Anticholinergic Cognitive Burden (ACB) Scale; and (2) to determine the association of anticholinergic burden and engagement in activity.

Design

Cross-sectional, using baseline data from an ongoing clinical trial.

Setting

Nine nursing homes in Pennsylvania.

Participants

Eighty-seven nursing home residents with dementia

Measurements

The ACB Scale was used to classify the severity of each resident's prescribed drugs’ anticholinergic activity on cognition. Engagement in activity was measured by direct observation using a standard instrument.

Results

Across 775 observations, subjects were active approximately 54% of the time, doing nothing 24% of the time, and asleep over 21% of the time. Seventy-one (81.6%) subjects were prescribed at least one drug with anticholinergic properties and 32 (36.7%) were prescribed at least one drug with severe anticholinergic properties. On average, subjects had a total ACB score of 2.55 (± 1.9). Mental status (MMSE) and dependency (PGDRS) were associated with engagement, but use of anticholinergic drugs was not.

Conclusion

Nursing home residents are prescribed many drugs with anticholinergic properties. The ACB Scale has utility as a tool to alert practitioners to high anticholinergic burden, who can then use this information when choosing between equally efficacious medications. Further study using larger samples of persons with dementia in earlier stages of the disease, and use of intense measurement designs are needed to more clearly determine the association of ACB with quality of life indicators.

Keywords: Anticholinergic burden, activity, nursing home residents, dementia

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 A.K. acknowledges support from The National Institute of Nursing Research: R01 NR008910.

 D.M.F. is supported in part by a grant from the National Institute on Aging: R03 AG023216.

 J.C. acknowledges support from the Hartford Building Academic Geriatric Nursing Capacity Scholarship and the University of Florida Alumni Fellowship. M.B. is supported by a grant (K23 AG 26770–01) from the John A. Hartford Foundation, the Atlantic Philanthropies, the Starr Foundation, and the National Institute on Aging.

PII: S1525-8610(08)00424-6

doi:10.1016/j.jamda.2008.11.005

JAMDA
Volume 10, Issue 4 , Pages 252-257, May 2009

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