Anticholinergic drug exposure is associated with delirium and postdischarge institutionalization in acutely ill hospitalized older patients

Abstract

Several studies investigated the possible association between anticholinergic drugs and diverse clinical outcomes in older persons, but the results are inconsistent. The aim of this study was to investigate whether anticholinergic drug exposure is associated with delirium on admission, length of hospital stay, postdischarge institutionalization and in‐hospital mortality in acutely ill hospitalized older patients. In this observational chart review study, we included acutely ill patients aged 65 and older who were admitted to the geriatric ward of the Erasmus University Medical Center, Rotterdam, The Netherlands, between 2012 and 2015 (n = 905). Anticholinergic drug exposure on admission was defined as the use of anticholinergic drugs, total number of anticholinergic drugs and anticholinergic drug burden score (ADB), quantified with the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden scale (ACB) and the list of Chew et al. (Chew). Logistic regression analyses were performed to investigate possible associations between anticholinergic drug exposure and the aforementioned outcomes. Analyses were adjusted for age, sex, comorbidities, non‐anticholinergic drugs and delirium, where appropriate. Moderate and high ADB measured with the ARS were associated with delirium on admission with odds ratios (OR) of 1.70 (95% confidence interval (CI) = 1.16–2.49) and 1.83 (95% CI = 1.06–3.15), respectively. High ADB measured with the ARS was also associated with postdischarge institutionalization (OR = 2.43, 95% CI = 1.24–4.75). No associations were found using the ACB and Chew. Future studies are warranted to investigate the clinical usefulness of the ARS in reducing complications in older persons.

Increased neutrophil–lymphocyte ratio in delirium: a pilot study

“…Acutely ill patients were defined as patients with an acute disease whereby a hospital admission was required for medical treatment. Patients hospitalized for less than 3 days, admitted for elective (diagnostic) procedures, or with missing data on drug use or outcome measures were not included 17. In the present pilot study, we included all patients enrolled in the previous study in whom the differential WBC counts as well as the CRP level were determined within 24 h after admission.…”

Pattern of treatment of behavioural and psychological symptoms of dementia and pain: evidence on pharmacoutilization from a large real-world sample and from a centre for cognitive disturbances and dementia

“…A high rate of use of antidepressants has been described also in other European countries [51][52][53][54][55]. This aspect has a fundamental importance because, despite the potential of antidepressants for neurogenesis [56,57], the use of drugs endowed with anticholinergic burden can worsen cognitive decline, increase the risk of falls, institutionalization, and mortality [58][59][60][61][62][63][64][65]. Therefore, antidepressants in demented patients should be prescribed only after appropriate diagnosis and with regular follow-up, since the efficacy and safety of these drugs still awaits support from large, rigorous clinical trials [66,67].…”

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

“…Four papers utilized more than one measure to assess ACB within the same cohort of individuals Chatterjee et al (2017), Egberts et al (2017), Gutieŕrez-Valencia et al (2017), Mangoni et al (2013). Chatterjee et al (2017) compared ADS with ACBS, whereby ADS resulted in significantly higher odds ratios than ACBS [ADS level 2/3: OR 1.37 (95%CI 1.34, 1.40); ACBS level 2/ 3: OR 1.24 (95%CI 1.21, 1.27)].…”

“…Data provided by Egberts et al (2017) compared ARS, ACBS, and Chew. Most results showed no significant association, with wide CIs (Table 3).…”

“…Four papers (three prospective cohorts, one retrospective cohort) reported measures used only once eachAgar et al (2010),Egberts et al (2017),Gutieŕrez-Valencia et al (2017),…”