Abstract
Objectives
Anticholinergic drugs have several side effects, and they have been associated with
adverse outcomes, particularly in older patients. The aim of this study was to analyze
anticholinergic burden and its relationship to delirium and mortality in older acutely
ill medical patients.
Design
Cohort study.
Setting and Participants
Patients 65 years of age and older who were admitted to an Internal Medicine ward
between August 1 and December 31, 2016.
Methods
Anticholinergic drug use, outpatient and inpatient, was assessed using the Anticholinergic
Cognitive Burden Scale (ACB). Prevalent delirium was diagnosed by the Short Confusion
Assessment Method (Short-CAM).
Results
Of the 198 patients, 28.3% developed delirium. Mortality rate was 13.6% in-hospital
and 45.6% at 12 months. In multivariate analysis, outpatient ACB was associated with
delirium, with an odds ratio (OR) of 1.65 [95% confidence interval (CI) 1.09-2.51].
Those with delirium had longer hospital stays (median 13 vs 8 days; P = .01), received more drugs (median 18 vs 15; P = .02), and presented a higher inpatient ACB (mean 3.9 vs 3.1; P = .034). No increased risk was found for in-hospital or 12-month mortality with drug
use, ACB, or delirium.
Discussion
In the population studied, we found an association between anticholinergic burden
as measured by the ACB and the presence of delirium, but not with mortality at 12 months.
A very high 12-month mortality rate might have been an obstacle for association recognition.
Conclusions and Implications
Clinician awareness of possible drug side effects, especially in older populations,
is crucial. As part of medication reconciliation at the time of hospitalization, ACB
of prehospitalization medications should be routinely calculated by inpatient pharmacy
services and made available to medical teams.
Keywords
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Article info
Publication history
Published online: January 23, 2020
Footnotes
M.M.S.'s work was supported by Project “NORTE-01-0145-FEDER-000016” (NanoSTIMA), financed by the North Portugal Regional Operational Program NORTE 2020, under the PORTUGAL 2020 Partnership Agreement and the European Regional Development Fund (ERDF).
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
