Anticholinergic burden and 1‐year mortality among older patients discharged from acute care hospital

Lattanzio, Fabrizia; Corica, Francesco; Schepisi, Roberto; Amantea, Diana; Bruno, Francesco; Cozza, Annalisa; Onder, Graziano; Volpato, Stefano; Cherubini, Antonio; Ruggiero, Carmelinda; Maggio, Marcello; Corsonello, Andrea

doi:10.1111/ggi.13234

Cited by 23 publications

(24 citation statements)

References 31 publications

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“…In fact, falls are a frequent cause of hospitalization and institutionalization among old people (Zia et al, 2016). Anticholinergics intake has been associated with the presence of recurrent falls, although there is no definitive evidence in this regard (Lattanzio et al, 2018). It has been suggested that drugs with anticholinergic action may not be independently associated with the risk of falls and fractures (Fraser et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…There are no conclusive results about greater mortality in hospitalized elderly patients taking anticholinergics. However, mortality has been associated with anticholinergic use in the presence of hyponatremia (Lowry et al, 2011) or delirium (Mangoni et al, 2013), especially in the presence of cognitive impairment (Lattanzio et al, 2018), even 1 year after discharge.…”

Section: Discussionmentioning

confidence: 99%

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Anticholinergic Drugs in Geriatric Psychopharmacology

López-Álvarez¹,

Sevilla‐Llewellyn‐Jones

Agüera-Ortíz³

2019

Front. Neurosci.

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Drugs with anticholinergic action are widely prescribed in the elderly population due to their potential clinical benefits. However, these benefits are limited by adverse effects which may be serious in particular circumstances. This review presents different aspects of the use of anticholinergics in old age with a focus in psychogeriatric patients. We critically review published data on benefits and disadvantages of anticholinergics, which are often controversial. Prevalence, pathophysiology and measurement methods of the anticholinergic action of drugs are discussed. We also present the most important drawbacks resulting from its use, including effects on cognition in healthy and cognitively impaired people, in aged schizophrenia patients, emergence of delirium and psychiatric symptoms, influence in functionality, hospitalization, institutionalization and mortality, and the potential benefits and limitations of their discontinuation. Finally, we suggest practical recommendations for the safe use of anticholinergics in clinical conditions affecting elderly patients, such as dementia, schizophrenia and acute hallucinatory episodes, depression, anxiety, Parkinson’s disease, cardiovascular conditions and urinary incontinence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anticholinergic Drugs in Geriatric Psychopharmacology

López-Álvarez¹,

Sevilla‐Llewellyn‐Jones

Agüera-Ortíz³

2019

Front. Neurosci.

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“…A total of 498,056 older individuals participated across the 18 studies, with a sample size range of 71 to 245,410 (McIsaac et al, 2018) people. Two identical study cohorts were each used twice in separate papers (Lattanzio 2018A (Lattanzio et al, 2018a and B (Lattanzio et al, 2018b);Lowry 2011(Lowry et al, 2011(Lowry et al, 2012); as a result, participants were only counted once. Ages ranged from mean 71 years (SD 12) (Agar et al, 2010) to median 93 years (IQR 91-95) (Kidd et al, 2014).…”

Section: Resultsmentioning

confidence: 99%

“…If multiple results were provided in the same study, the most appropriate result was chosen to be included in the metaanalyses by two researchers (CS and KG) so as not to duplicate the same study population within one meta-analysis (see results). For Lattanzio 2018 A (Lattanzio et al, 2018a) and Lattanzio 2018B (Lattanzio et al, 2018b, one cohort was used for both studies. Again, to avoid cohort duplication, data assessing ACB on the cohort as a whole (Lattanzio 2018A (Lattanzio et al, 2018a) were chosen as more generalizable than data produced after stratification of individuals by Basic Activities of Daily Living (BADL) scores.…”

Section: Strategy For Data Synthesismentioning

confidence: 99%

“…For Lattanzio 2018 A (Lattanzio et al, 2018a) and Lattanzio 2018B (Lattanzio et al, 2018b, one cohort was used for both studies. Again, to avoid cohort duplication, data assessing ACB on the cohort as a whole (Lattanzio 2018A (Lattanzio et al, 2018a) were chosen as more generalizable than data produced after stratification of individuals by Basic Activities of Daily Living (BADL) scores.…”

Section: Strategy For Data Synthesismentioning

confidence: 99%

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The Prognostic Value of Anticholinergic Burden Measures in Relation to Mortality in Older Individuals: A Systematic Review and Meta-Analysis

et al. 2020

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Background: Greater anticholinergic burden (ACB) increases the risk of mortality in older individuals, yet the strength of this association varies between studies. One possible explanation for this variance is the use of different approaches to quantify ACB. This systematic review (PROSPERO number CRD42019115918) assessed the prognostic utility of ACB-specific measures on mortality in older individuals. Methods:Multiple cross-disciplinary databases were searched from 2006-2018. Observational studies assessing the association between ACB and mortality utilizing ≥1 ACB measure, involving persons aged ≥65 years were included. Screening and data extraction were performed by two independent reviewers, with disagreements resolved by a third independent reviewer. Risk of bias and quality of evidence were assessed using Quality in Prognosis Studies (QUIPS) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. Meta-analysis was conducted where appropriate.Results: Of 19,224 titles, 20 articles describing 18 cohort studies involving 498,056 older individuals were eligible. Eight anticholinergic-specific measures were identified; the Anticholinergic Cognitive Burden Scale (ACBS, n=9) and Anticholinergic Risk scale (ARS, n=8) were most frequently reported. The evidence base was of poor quality, with moderate to high risk of bias. Meta-analysis showed increased mortality risk.Conclusions: There was a modest association between some ACB measures and mortality, with most evidence derived from the ACBS. Studies comparing different measures within the same population were lacking. Analysis was limited by poor generalizability between studies, specifically regarding heterogeneity in methodology and reporting, as well as high risk of bias for most studies in the evidence base.

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Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome

Taylor‐Rowan

Edwards

Noel-Storr

et al. 2021

Cochrane Database of Systematic Reviews

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This is a protocol for a Cochrane Review (Prognosis). The objectives are as follows:Primary objective: to assess whether ACB in older adults is a prognostic factor for future cognitive decline or dementia. Secondary objective(s):to assess whether ACB is a prognostic factor for older adults recruited in primary care, secondary care, or community settings (with setting used as the basis for subgroup analyses); whether ACB is associated with mortality; to compare the prognostic validity of respective ACB scales; and to examine the e ect of duration of exposure and duration of follow-up on the ACBdementia risk association.Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome (Protocol)

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Anticholinergic burden and 1‐year mortality among older patients discharged from acute care hospital

Cited by 23 publications

References 31 publications

Anticholinergic Drugs in Geriatric Psychopharmacology

Anticholinergic Drugs in Geriatric Psychopharmacology

The Prognostic Value of Anticholinergic Burden Measures in Relation to Mortality in Older Individuals: A Systematic Review and Meta-Analysis

Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome

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