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Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study.
BMC Geriatr. 2016 Sep 21; 16(1):162.BG

Abstract

BACKGROUND

Older people are commonly prescribed multiple medications, including medications with anticholinergic effects. Polypharmacy and anticholinergic medications may be risk factors for the development of delirium.

METHODS

Patients from a medical admission unit who were over 70, with DSM-IV diagnosed delirium and patients without delirium, were investigated. Number of drugs prescribed on admission and anticholinergic burden using two scales (the Anticholinergic Cognitive Burden Scale [ACB] and the Anticholinergic Drug Scale [ADS]) were recorded from electronic prescribing records. The relationship and predictive ability of these were explored.

RESULTS

The sample included 125 patients with DSM-IV diagnosed delirium and 122 patients without delirium. The mean age of the sample was 84.0 years. The median number of drugs prescribed was 7: 79.8 % were prescribed ≥5 drugs and 29.0 % ≥10 drugs. The median ACB score was 1 and the median ADS score was 1.5. 73.4 % of patients had an ACB score of ≥1 and 73.0 % had a ADS score ≥1. There was no association between: number of drugs prescribed, rate of polypharmacy, rate of excessive polypharmacy, ACB score and ADS score, and a diagnosis of delirium on admission. Only acetylcholinesterase inhibitor use predicted delirium (OR 3.86, p = 0.04) and the number of drugs prescribed was negatively correlated with age (spearman rho = -0.18, p = 0.006).

CONCLUSION

Neither number of drugs prescribed, polypharmacy or anticholinergic burden were associated with delirium on admission, questioning the clinical usefulness of anticholinergic drug scales. Further research is needed to unpick fully the relationship between, drugs, anticholinergic burden, age, and prevalent delirium in older patients and whether there is any role for these scales in clinical practice.

Authors+Show Affiliations

Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. T.Jackson@bham.ac.uk. Department of Geritric Medicine, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK. T.Jackson@bham.ac.uk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27655289

Citation

Moorey, Hannah C., et al. "Delirium Is Not Associated With Anticholinergic Burden or Polypharmacy in Older Patients On Admission to an Acute Hospital: an Observational Case Control Study." BMC Geriatrics, vol. 16, no. 1, 2016, p. 162.
Moorey HC, Zaidman S, Jackson TA. Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study. BMC Geriatr. 2016;16(1):162.
Moorey, H. C., Zaidman, S., & Jackson, T. A. (2016). Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study. BMC Geriatrics, 16(1), 162.
Moorey HC, Zaidman S, Jackson TA. Delirium Is Not Associated With Anticholinergic Burden or Polypharmacy in Older Patients On Admission to an Acute Hospital: an Observational Case Control Study. BMC Geriatr. 2016 Sep 21;16(1):162. PubMed PMID: 27655289.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study. AU - Moorey,Hannah C, AU - Zaidman,Sebastian, AU - Jackson,Thomas A, Y1 - 2016/09/21/ PY - 2016/05/27/received PY - 2016/09/13/accepted PY - 2016/9/23/entrez PY - 2016/9/23/pubmed PY - 2016/9/23/medline KW - Acetylcholine KW - Aged KW - Anticholinergic KW - Delirium KW - Polypharmacy KW - Risk factor SP - 162 EP - 162 JF - BMC geriatrics JO - BMC Geriatr VL - 16 IS - 1 N2 - BACKGROUND: Older people are commonly prescribed multiple medications, including medications with anticholinergic effects. Polypharmacy and anticholinergic medications may be risk factors for the development of delirium. METHODS: Patients from a medical admission unit who were over 70, with DSM-IV diagnosed delirium and patients without delirium, were investigated. Number of drugs prescribed on admission and anticholinergic burden using two scales (the Anticholinergic Cognitive Burden Scale [ACB] and the Anticholinergic Drug Scale [ADS]) were recorded from electronic prescribing records. The relationship and predictive ability of these were explored. RESULTS: The sample included 125 patients with DSM-IV diagnosed delirium and 122 patients without delirium. The mean age of the sample was 84.0 years. The median number of drugs prescribed was 7: 79.8 % were prescribed ≥5 drugs and 29.0 % ≥10 drugs. The median ACB score was 1 and the median ADS score was 1.5. 73.4 % of patients had an ACB score of ≥1 and 73.0 % had a ADS score ≥1. There was no association between: number of drugs prescribed, rate of polypharmacy, rate of excessive polypharmacy, ACB score and ADS score, and a diagnosis of delirium on admission. Only acetylcholinesterase inhibitor use predicted delirium (OR 3.86, p = 0.04) and the number of drugs prescribed was negatively correlated with age (spearman rho = -0.18, p = 0.006). CONCLUSION: Neither number of drugs prescribed, polypharmacy or anticholinergic burden were associated with delirium on admission, questioning the clinical usefulness of anticholinergic drug scales. Further research is needed to unpick fully the relationship between, drugs, anticholinergic burden, age, and prevalent delirium in older patients and whether there is any role for these scales in clinical practice. SN - 1471-2318 UR - https://www.unboundmedicine.com/medline/citation/27655289/Delirium_is_not_associated_with_anticholinergic_burden_or_polypharmacy_in_older_patients_on_admission_to_an_acute_hospital:_an_observational_case_control_study_ L2 - https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-016-0336-9 DB - PRIME DP - Unbound Medicine ER -
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