Prevalence and Factors Associated with Cumulative Anticholinergic Burden Among Older Long-Stay Nursing Home Residents with Overactive Bladder

Abstract

Background Overactive bladder (OAB), the primary cause of urinary incontinence in nursing homes, is commonly treated with anticholinergic medications; however, the elderly population is vulnerable to the adverse effects associated with anticholinergic burden. Given the relatively high prevalence of OAB among nursing home residents, it is important to understand the magnitude of anticholinergic burden in this population. Objectives The objectives of this study were to (1) examine the prevalence of cumulative anticholinergic burden among long-stay nursing home (LSNH) residents with OAB; and (2) identify the factors associated with varying levels of cumulative anticholinergic burden. Methods This was a retrospective, cohort study using Minimum Data Set-linked Medicare claims data. Anticholinergic burden was determined based on the Anticholinergic Cognitive Burden scale and patient-specific dosing using defined daily dose. The Andersen Behavioral Model framework was used to identify the predisposing, enabling, and need factors associated with levels of anticholinergic burden. Multivariable logistic regression models were developed to determine the factors associated with levels of anticholinergic burden. Results A total of 123,308 LSNH residents with OAB were identified; 87.2% had some degree of anticholinergic burden and 27.3% had high cumulative burden. Multiple factors were associated with higher levels of burden, including younger age, female sex, and non-Hispanic White ethnicity (predisposing factors); dual eligibility, Southern geographic region, and rural residence (enabling factors); and a number of comorbidities and concomitant medications (need factors). Conclusions This study revealed a high level of anticholinergic burden among LSNH residents. Multiple factors were associated with a high level of burden. There is a need to optimize the use of anticholinergics due to their significant safety concerns in the LSNH setting.

The Costs and Healthcare Resource Utilization Associated with Anticholinergic Burden in Long-Stay Nursing Home Residents with Overactive Bladder in the US

“…Finally, a population-based study of elderly individuals in Finland revealed that level of anticholinergic burden was associated with a greater risk of hospitalization [23]. Although there is extensive anticholinergic use and associated anticholinergic burden among nursing home residents [25,26], the extent to which anticholinergic burden is associated with healthcare resource use (HCRU) and costs in a nursing home setting is currently unknown.…”

“…We recently evaluated anticholinergic burden among long-stay nursing home (LSNH) residents and found that nearly 90% of those with OAB were exposed to varying levels of burden, two-thirds of whom demonstrated moderate-to-high levels. Level of exposure (no, low, moderate, or high) was ascertained by evaluating a drug's anticholinergic activity and patient-specific dosing [25]. Given the anticholinergic burden and impact of this burden on healthcare, it is particularly important to assess the healthcare resource utilization and costs associated with anticholinergic burden among LSNH to understand the resource implications of managing OAB.…”

“…The presence of OAB was based on inpatient and/or outpatient International Classification of Diseases Ninth/Tenth Revision (ICD-9/10) diagnosis codes or a claim for an OAB-specific medication based on prescription fill records or CPT codes during the study period. Specific diagnostic and medication codes, as well as a schematic of patient enrollment and follow-up, are available in the study by Chatterjee et al [25].…”

“…Previously published cut-off values of cumulative SumSDACE scores were used to classify patients with no (0), low (1-89), moderate (90-499), or high (≥ 500) anticholinergic burden [34]. Additional detail regarding the calculation of cumulative anticholinergic exposure can be found in the study by Chatterjee et al [25].…”