Abstract
Aim
Increasing evidence from experimental studies and clinical observations suggests that
drugs with anticholinergic properties can cause physical and mental impairment. The
aim of the present study was to evaluate the relationship between the use of drugs
with anticholinergic activity and negative outcomes in older nursing home residents.
Methods
We used data from the database of the U.L.I.S.S.E project (Un Link Informatico sui
Servizi Sanitari Esistenti per l'Anziani), a prospective multicenter observational
study. Patients from 31 facilities in Italy were assessed at baseline and at 6 and
12 months by trained personnel, using the Minimum Data Set for Nursing Home (MDS-NH).
The only exclusion criterion was age younger than 65 years. The Anticholinergic Risk
Scale (ARS), a list of commonly prescribed drugs with potential anticholinergic effects,
was used to calculate the anticholinergic load.
Results
A total population of 1490 patients was analyzed; almost half of the sample (48%)
was using drugs with anticholinergic properties. The population of patients with ARS
1 or higher had a higher comorbidity index (P < .003) and greater cognitive impairment (CPS 5–6) (P < .007). They were more likely to suffer from heart failure, Parkinson disease, depression,
anxiety, and schizophrenia. In multivariate analysis, a higher score in the ARS scale
was associated with a greater likelihood of functional decline (described as the loss
of ≥1 ADL point) (odds ratio [OR] 1.13; confidence interval [CI] 1.03–1.23), to a
higher rate of falls (OR 1.26; CI 1.13–1.41), and to a higher incidence of delirium
(OR 1.16; CI 1.02–1.32) during a 1-year follow-up.
Conclusions
The use of medications with anticholinergic properties is common among older nursing
home residents. Our results suggest that among older nursing home residents the use
of anticholinergic drugs is associated with important negative outcomes, such as functional
decline, falls, and delirium.
Keywords
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Article info
Publication history
Published online: October 02, 2014
Footnotes
The authors declare no conflicts of interest.
The U.L.I.S.S.E. project was funded by the Italian Ministry of Health and by Pfizer Srl Italy. The funding public agencies and the private sponsor had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, in the preparation, review, or approval of the manuscript.
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© 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
