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Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation.
Am J Geriatr Pharmacother. 2012 Aug; 10(4):251-7.AJ

Abstract

BACKGROUND

Medications with anticholinergic (antimuscarinic) effects negatively affect physical and cognitive function in community-dwelling older patients. However, it is unknown if anticholinergic drugs exert detrimental effects in older patients undergoing rehabilitation.

OBJECTIVE

The purpose of our study was to assess the effect of anticholinergic drug exposure on functional outcomes in older patients undergoing rehabilitation. We speculated that higher anticholinergic drug exposure would be associated with reduced functional outcomes in this group.

METHODS

Data on clinical characteristics, full medication, anticholinergic drug exposure (total number of anticholinergic drugs [tAD] and Anticholinergic Risk Scale [ARS] score), and Barthel index (BI) score were collected on admission and discharge in a consecutive series of 117 older patients (age 79 [7] years) admitted to the orthopaedic rehabilitation unit of a teaching hospital between July 2010 and March 2011. Outcome measures were BI changes (BI on discharge - BI on admission) during rehabilitation (primary outcome) and length of stay (secondary outcome).

RESULTS

Anticholinergic drugs were prescribed in 38 patients (32.5%). Median and interquartile range for tAD = 0 (0-1); for ARS = 0 (0-1). Poisson regression showed that higher tAD (incidence rate ratio [IRR] = 0.92; 95% CI, 0.88-0.97; P = 0.003) and ARS scores (IRR = 0.97; 95% CI, 0.95-0.99; P = 0.008) on admission independently predicted lower BI changes. Being a woman (IRR = 0.87; 95% CI, 0.78-0.97; P = 0.01), lower Abbreviated Mental Test scores (IRR = 0.94; 95% CI, 0.91-0.97; P < 0.001), and lower BI on admission (IRR = 0.98; 95% CI, 0.97-0.98; P < 0.001), but not tAD or ARS scores, independently predicted increasing length of stay.

CONCLUSIONS

Higher anticholinergic drug exposure on admission independently predicts reduced functional outcomes, but not length of stay, in older patients undergoing orthopaedic rehabilitation.

Authors+Show Affiliations

Department of Rehabilitation Medicine, Woodend Hospital, NHS Grampian, Aberdeen, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22795433

Citation

Koshoedo, Sejlo, et al. "Anticholinergic Drugs and Functional Outcomes in Older Patients Undergoing Orthopaedic Rehabilitation." The American Journal of Geriatric Pharmacotherapy, vol. 10, no. 4, 2012, pp. 251-7.
Koshoedo S, Soiza RL, Purkayastha R, et al. Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation. Am J Geriatr Pharmacother. 2012;10(4):251-7.
Koshoedo, S., Soiza, R. L., Purkayastha, R., & Mangoni, A. A. (2012). Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation. The American Journal of Geriatric Pharmacotherapy, 10(4), 251-7. https://doi.org/10.1016/j.amjopharm.2012.06.003
Koshoedo S, et al. Anticholinergic Drugs and Functional Outcomes in Older Patients Undergoing Orthopaedic Rehabilitation. Am J Geriatr Pharmacother. 2012;10(4):251-7. PubMed PMID: 22795433.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation. AU - Koshoedo,Sejlo, AU - Soiza,Roy L, AU - Purkayastha,Rajib, AU - Mangoni,Arduino A, Y1 - 2012/07/13/ PY - 2012/05/02/received PY - 2012/06/22/revised PY - 2012/06/27/accepted PY - 2012/7/17/entrez PY - 2012/7/17/pubmed PY - 2013/1/10/medline SP - 251 EP - 7 JF - The American journal of geriatric pharmacotherapy JO - Am J Geriatr Pharmacother VL - 10 IS - 4 N2 - BACKGROUND: Medications with anticholinergic (antimuscarinic) effects negatively affect physical and cognitive function in community-dwelling older patients. However, it is unknown if anticholinergic drugs exert detrimental effects in older patients undergoing rehabilitation. OBJECTIVE: The purpose of our study was to assess the effect of anticholinergic drug exposure on functional outcomes in older patients undergoing rehabilitation. We speculated that higher anticholinergic drug exposure would be associated with reduced functional outcomes in this group. METHODS: Data on clinical characteristics, full medication, anticholinergic drug exposure (total number of anticholinergic drugs [tAD] and Anticholinergic Risk Scale [ARS] score), and Barthel index (BI) score were collected on admission and discharge in a consecutive series of 117 older patients (age 79 [7] years) admitted to the orthopaedic rehabilitation unit of a teaching hospital between July 2010 and March 2011. Outcome measures were BI changes (BI on discharge - BI on admission) during rehabilitation (primary outcome) and length of stay (secondary outcome). RESULTS: Anticholinergic drugs were prescribed in 38 patients (32.5%). Median and interquartile range for tAD = 0 (0-1); for ARS = 0 (0-1). Poisson regression showed that higher tAD (incidence rate ratio [IRR] = 0.92; 95% CI, 0.88-0.97; P = 0.003) and ARS scores (IRR = 0.97; 95% CI, 0.95-0.99; P = 0.008) on admission independently predicted lower BI changes. Being a woman (IRR = 0.87; 95% CI, 0.78-0.97; P = 0.01), lower Abbreviated Mental Test scores (IRR = 0.94; 95% CI, 0.91-0.97; P < 0.001), and lower BI on admission (IRR = 0.98; 95% CI, 0.97-0.98; P < 0.001), but not tAD or ARS scores, independently predicted increasing length of stay. CONCLUSIONS: Higher anticholinergic drug exposure on admission independently predicts reduced functional outcomes, but not length of stay, in older patients undergoing orthopaedic rehabilitation. SN - 1876-7761 UR - https://www.unboundmedicine.com/medline/citation/22795433/Anticholinergic_drugs_and_functional_outcomes_in_older_patients_undergoing_orthopaedic_rehabilitation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1543-5946(12)00090-6 DB - PRIME DP - Unbound Medicine ER -