Associations between different measures of anticholinergic drug exposure and Barthel Index in older hospitalized patients

Abstract

Objective: To compare associations between four measures of anticholinergic exposure (anticholinergic risk scale, ARS; anticholinergic drug burden, DB AC ; number and use versus no use of anticholinergic drugs), Barthel Index (BI, physical function) and Abbreviated Mental Test (AMT, cognitive function) on admission in older hospitalized patients. Methods: Prospective observational study of a consecutive series of 271 older patients (age 83 ± 7 years) from community-dwelling and institutionalized settings, admitted to an acute geriatric admission unit between 28 September 2011 and 18 December 2011. The main outcome measures were BI quartiles (primary outcome) and AMT (secondary outcome) on admission. Results: Anticholinergic prevalence was 47%. Multinomial logistic regression showed higher DB AC was associated with a greater risk of being in the lower BI quartiles versus highest BI quartile (Q4). This risk was significant for Q3 (p = 0.04) and Q2 (p = 0.02) but not for Q1 (p = 0.06). A greater number of anticholinergic drugs was associated with a higher risk of being in Q2 (p = 0.02). This risk was not significant for either Q3 (p = 0.10) or Q1 (p = 0.06). No significant associations were observed either with use of anticholinergic medication or with ARS and BI quartiles. AMT did not show independent associations with any of the four measures of anticholinergic exposure. Conclusion: In older hospitalized patients, DB AC and some crude measures of anticholinergic exposure, but not ARS, showed independent associations with lower BI, but not AMT. These results highlight differences between various measures of anticholinergic drug exposure when studying their associations with functional status.

Association Between Objectively Measured Physical Activity and Opioid, Hypnotic, or Anticholinergic Medication Use in Older People: Data from the Physical Activity Cohort Scotland Study

“…Whilst doing so might have given additional information on dose-response, achieving accurate dose equivalence across different medications is very difficult and likely to introduce error. There are a number of different anticholinergic scores in use; although we chose one that is appropriate to UK prescribing practice, different scales have yielded different strengths of association with outcomes in previous studies [29].…”

Measuring anticholinergic drug exposure in older community‐dwelling Australian men: a comparison of four different measures

“…Each of the four scales identified above has been associated with significant clinical outcomes in older persons. Across the scales, increasing anticholinergic drug exposure has been found associated with falls [9], poorer cognitive function [7,8,11,12], increased adverse effects [6], functional decline [11,13,14], institutionalization [15] and increased mortality [16]. However different associations have been reported for each scale.…”

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

“…One explanation may lie in how ACB was quantified. To date, multiple measures exist to assess ACB but differences are apparent between measures in terms of which medications are included and the level of anticholinergic potency attributed to individual medications (Bostock et al, 2013;Salahudeen et al, 2015). For example, clomipramine is assessed as having "high" potency according to Boustani et al (2008) and Carnahan et al (2006), yet this drug is not included in the analysis by Rudolph et al (2008).…”