Is anticholinergic and sedative drug burden associated with postdischarge institutionalization in community‐dwelling older patients acutely admitted to hospital? A Norwegian registry‐based study

Abstract

Purpose Investigate the association between anticholinergic (AC) and sedative (SED) drug burden before hospitalization and postdischarge institutionalization (PDI) in community‐dwelling older patients acutely admitted to hospital. Methods A cross‐sectional study using data from the Norwegian Patient Registry and the Norwegian Prescription Database. We studied acutely hospitalized community‐dwelling patients ≥70 years during 2013 (N = 86 509). Patients acutely admitted to geriatric wards underwent subgroup analyses (n = 1715). We calculated drug burden by the Drug Burden Index (DBI), use of AC/SED drugs, and the number of AC/SED drugs. Piecewise linearity of DBI versus PDI and a knot point (DBI = 2.45) was identified. Statistical analyses included an adjusted multivariable logistic regression model. Results In the total population, 45.4% were exposed to at least one AC/SED drug, compared to 52.5% in the geriatric subgroup. AC/SED drugs were significantly associated with PDI. The DBI with odds ratios (ORs) of 1.11 (95% CI 1.07–1.15) for DBI < 2.45 and 1.08 (95% CI 1.04–1.13) for DBI ≥ 2.45. The number of AC/SED drugs with OR of 1.07 (95% CI 1.05–1.09). The AC component of DBI with OR 1.23 and the number of AC drugs with OR 1.13. In the subgroup, ORs were closer to 1 for AC drugs. Conclusions The use of AC/SED drugs was highly prevalent in older patients before acute hospital admissions, and significantly associated with PDI. The number, or just using AC/SED drugs, gave similar associations with PDI compared to applying the DBI. Using AC drugs showed higher sensitivity, indicating that to reduce the risk of PDI, a clinical approach could be to reduce the number of AC drugs.

Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review

“…Full‐text articles were sought and screened for 316 articles that appeared to meet the inclusion criteria. Seventy studies 6,13–81 were included in the systematic review (Figure 1).…”

“…The details of the included studies are summarized in Supplementary Table S1. There were 65 studies conducted in humans 6,13–76 and five in animals (mice) 77–81 . Of the studies conducted in humans, there were 38 cross‐sectional studies, 14 retrospective cohort studies, 11 prospective cohort studies, one case–control study, and one mixed prospective/retrospective cohort study.…”

Anticholinergic burden risk and prevalence of medications carrying anticholinergic properties in elderly cancer patients in Jordan

“…Recent studies from all around the world showed significant variations in prevalence rates of anticholinergic effects exposure. ( Cebron Lipovec et al, 2020 , Cross et al, 2016 , Havnes et al, 2023 , Mantri et al, 2019 , Mayer et al, 2017 , Salahudeen et al, 2015b , Tristancho-Perez et al, 2021 ). This significant difference in our study regarding anticholinergic burden prevalence could be due to many factors, including first, the utilization of a newer anticholinergic burden scale (CALS) where the list of potential anticholinergic drugs contains 217 drugs ( Ramos et al, 2022 ).…”