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Measures of anticholinergic drug exposure, serum anticholinergic activity, and all-cause postdischarge mortality in older hospitalized patients with hip fractures.
Am J Geriatr Psychiatry. 2013 Aug; 21(8):785-93.AJ

Abstract

OBJECTIVES

To assess possible associations between anticholinergic drug exposure and serum anticholinergic activity (SAA) and their capacities to predict all-cause mortality in older hospitalized patients.

SETTING

Academic medical center.

PARTICIPANTS AND MEASUREMENTS

Data on clinical characteristics, full medication exposure, SAA, and 4 anticholinergic drug scoring systems (ADSSs: Anticholinergic Risk Scale [ARS], Anticholinergic Drug Scale, Anticholinergic Burden scale, and anticholinergic component of the Drug Burden Index) were collected in 71 older hospitalized patients (age 84 ± 6 years) awaiting surgical repair after hip fractures.

RESULTS

The median (range) SAA was 2.8 (1.1-4.9) pmol/mL. Age (ρ = 0.25, p = 0.03), Katz Index of Independence in Activities of Daily Living score (ρ = 0.39, p = 0.001), in-hospital delirium (ρ = 0.29, p = 0.01), preadmission cognitive impairment (ρ = 0.31, p = 0.01), and the number of nonanticholinergic drugs (n-NA, ρ = -0.27, p = 0.02) were associated with SAA. No significant associations were detected between ADSSs and SAA. Cognitive impairment (β = 2.1, 95% confidence interval [CI]: 0.7 to 2.5, p = 0.005) and n-NA (β = -0.3, 95% CI: -0.5 to -0.03, p = 0.03) were independently associated with SAA. Cognitive impairment (hazard ratio [HR]: 6.7, 95% CI: 1.1 to 40.3, p = 0.04) and higher ARS scores (HR: 2.2, 95% CI: 1.2 to 3.7, p = 0.006) independently predicted 3-month mortality whereas in-hospital delirium (HR: 3.6, 95% CI: 1.3 to 10.3, p = 0.02), living at home (HR: 0.2, 95% CI: 0.0 to 0.9, p = 0.03), and length of hospital stay (HR: 1.1, 95% CI: 1.0 to 1.2, p = 0.004) independently predicted 1-year mortality after adjustment for age, gender, and Charlson comorbidity index.

CONCLUSIONS

Cognitive impairment and n-NA, but not ADSSs, are independently associated with SAA in older hospitalized patients. The ARS score, together with cognitive impairment, in-hospital delirium, place of residence, and length of hospital stay, predicts all-cause mortality in this group.

Authors+Show Affiliations

Division of Applied Medicine, University of Aberdeen, and Department of Medicine for the Elderly, Woodend Hospital, NHS Grampian, Aberdeen, United Kingdom. Electronic address: a.a.mangoni@abdn.ac.uk.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

23567395

Citation

Mangoni, Arduino A., et al. "Measures of Anticholinergic Drug Exposure, Serum Anticholinergic Activity, and All-cause Postdischarge Mortality in Older Hospitalized Patients With Hip Fractures." The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, vol. 21, no. 8, 2013, pp. 785-93.
Mangoni AA, van Munster BC, Woodman RJ, et al. Measures of anticholinergic drug exposure, serum anticholinergic activity, and all-cause postdischarge mortality in older hospitalized patients with hip fractures. Am J Geriatr Psychiatry. 2013;21(8):785-93.
Mangoni, A. A., van Munster, B. C., Woodman, R. J., & de Rooij, S. E. (2013). Measures of anticholinergic drug exposure, serum anticholinergic activity, and all-cause postdischarge mortality in older hospitalized patients with hip fractures. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 21(8), 785-93. https://doi.org/10.1016/j.jagp.2013.01.012
Mangoni AA, et al. Measures of Anticholinergic Drug Exposure, Serum Anticholinergic Activity, and All-cause Postdischarge Mortality in Older Hospitalized Patients With Hip Fractures. Am J Geriatr Psychiatry. 2013;21(8):785-93. PubMed PMID: 23567395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Measures of anticholinergic drug exposure, serum anticholinergic activity, and all-cause postdischarge mortality in older hospitalized patients with hip fractures. AU - Mangoni,Arduino A, AU - van Munster,Barbara C, AU - Woodman,Richard J, AU - de Rooij,Sophia E, Y1 - 2013/02/06/ PY - 2011/11/02/received PY - 2011/12/06/revised PY - 2011/12/27/accepted PY - 2013/4/10/entrez PY - 2013/4/10/pubmed PY - 2014/11/5/medline KW - Anticholinergic drug scoring systems KW - cognitive impairment KW - delirium KW - mortality KW - older patients KW - serum anticholinergic activity SP - 785 EP - 93 JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry JO - Am J Geriatr Psychiatry VL - 21 IS - 8 N2 - OBJECTIVES: To assess possible associations between anticholinergic drug exposure and serum anticholinergic activity (SAA) and their capacities to predict all-cause mortality in older hospitalized patients. SETTING: Academic medical center. PARTICIPANTS AND MEASUREMENTS: Data on clinical characteristics, full medication exposure, SAA, and 4 anticholinergic drug scoring systems (ADSSs: Anticholinergic Risk Scale [ARS], Anticholinergic Drug Scale, Anticholinergic Burden scale, and anticholinergic component of the Drug Burden Index) were collected in 71 older hospitalized patients (age 84 ± 6 years) awaiting surgical repair after hip fractures. RESULTS: The median (range) SAA was 2.8 (1.1-4.9) pmol/mL. Age (ρ = 0.25, p = 0.03), Katz Index of Independence in Activities of Daily Living score (ρ = 0.39, p = 0.001), in-hospital delirium (ρ = 0.29, p = 0.01), preadmission cognitive impairment (ρ = 0.31, p = 0.01), and the number of nonanticholinergic drugs (n-NA, ρ = -0.27, p = 0.02) were associated with SAA. No significant associations were detected between ADSSs and SAA. Cognitive impairment (β = 2.1, 95% confidence interval [CI]: 0.7 to 2.5, p = 0.005) and n-NA (β = -0.3, 95% CI: -0.5 to -0.03, p = 0.03) were independently associated with SAA. Cognitive impairment (hazard ratio [HR]: 6.7, 95% CI: 1.1 to 40.3, p = 0.04) and higher ARS scores (HR: 2.2, 95% CI: 1.2 to 3.7, p = 0.006) independently predicted 3-month mortality whereas in-hospital delirium (HR: 3.6, 95% CI: 1.3 to 10.3, p = 0.02), living at home (HR: 0.2, 95% CI: 0.0 to 0.9, p = 0.03), and length of hospital stay (HR: 1.1, 95% CI: 1.0 to 1.2, p = 0.004) independently predicted 1-year mortality after adjustment for age, gender, and Charlson comorbidity index. CONCLUSIONS: Cognitive impairment and n-NA, but not ADSSs, are independently associated with SAA in older hospitalized patients. The ARS score, together with cognitive impairment, in-hospital delirium, place of residence, and length of hospital stay, predicts all-cause mortality in this group. SN - 1545-7214 UR - https://www.unboundmedicine.com/medline/citation/23567395/Measures_of_anticholinergic_drug_exposure_serum_anticholinergic_activity_and_all_cause_postdischarge_mortality_in_older_hospitalized_patients_with_hip_fractures_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1064-7481(13)00017-1 DB - PRIME DP - Unbound Medicine ER -