Abstract
Objectives
To determine whether anticholinergic burden may predict differently 1-year mortality
in older patients discharged from acute care hospitals with or without dependency
in basic activities of daily living (BADL).
Design
Prospective observational study.
Setting and participants
Our series consisted of 807 patients aged 65 years or older consecutively discharged
from 7 acute care geriatric wards throughout Italy between June 2010 and May 2011.
Measures
Overall anticholinergic burden was assessed by the anticholinergic cognitive burden
(ACB) score. Dependency was rated by BADL, and dependency in at least 1 BADL was considered
as a potential mediator in the analysis. The study outcome was all-cause mortality
during 12-months of follow-up.
Results
Patients included in the study were aged 81.0 ± 7.4 years, and 438 (54.3%) were female.
During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting
for potential confounders, discharge ACB score = 2 or more was significantly associated
with the outcome among patients with dependency in at least 1 BADL [hazard ratio (HR)
2.25 95% confidence (CI) 1.22‒4.14], but not among independent ones (HR 1.06 95% CI
0.50‒2.34). The association was confirmed among dependent patients after adjusting
for the number of lost BADL at discharge (HR 2.20 95% CI 1.18‒4.04) or ACB score at
3-month follow-up (HR 2.18 95% CI 1.20‒3.98), as well as when considering ACB score
as a continuous variable (HR 1.28 95% CI 1.11‒1.49). The interaction between ACB score
at discharge and BADL dependency was highly significant (P < .001).
Conclusions/Implications
ACB score at discharge may predict mortality among older patients discharged from
an acute care hospital carrying at least 1 BADL dependency. Hospital physicians should
be aware that prescribing anticholinergic medications in this population may have
negative prognostic implications and they should try to reduce anticholinergic burden
at discharge whenever possible.
Keywords
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Article info
Publication history
Published online: July 23, 2018
Footnotes
The CRiteria to assess Inappropriate Medication use among Elderly complex patients (CRIME) project was partially supported by a grant from the Italian Ministry of Health (GR-2007-685638).
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
