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Anticholinergic medications in patients admitted with cognitive impairment or falls (AMiCI). The impact of hospital admission on anticholinergic cognitive medication burden. Results of a multicentre observational study.
J Clin Pharm Ther. 2018 Oct; 43(5):682-694.JC

Abstract

WHAT IS KNOWN AND OBJECTIVE

Drugs with anticholinergic properties increase the risk of falls, delirium, chronic cognitive impairment, and mortality and counteract procholinergic medications used in the treatment of dementia. Medication review and optimisation to reduce anticholinergic burden in patients at risk is recommended by specialist bodies. Little is known how effective this review is in patients who present acutely and how often drugs with anticholinergic properties are used temporarily during an admission. The aim of the study was to describe the changes in the anticholinergic cognitive burden (ACB) in patients admitted to hospital with a diagnosis of delirium, chronic cognitive impairment or falls and to look at the temporary use of anticholinergic medications during hospital stay.

METHODS

This is a multi-centre observational study that was conducted in seven different hospitals in the UK, Finland, The Netherlands and Italy.

RESULTS AND DISCUSSION

21.1% of patients had their ACB score reduced by a mean of 1.7%, 19.7% had their ACB increased by a mean of 1.6%, 22.8% of DAP naïve patients were discharged on anticholinergic medications. There was no change in the ACB scores in 59.2% of patients. 54.1% of patients on procholinergics were taking anticholinergics. Out of the 98 medications on the ACB scale, only 56 were seen. Medications with a low individual burden were accounting for 64.9% of the total burden. Anticholinergic drugs were used temporarily during the admission in 21.9% of all patients. A higher number of DAPs used temporarily during admission was associated with a higher risk of ACB score increase on discharge (OR = 1.82, 95% CI for OR: 1.36-2.45, P < .001).

WHAT IS NEW AND CONCLUSION

There was no reduction in anticholinergic cognitive burden during the acute admissions. This was the same for all diagnostic subgroups. The anticholinergic load was predominantly caused by medications with a low individual burden. More than 1 in 5 patients not taking anticholinergics on admission were discharged on them and similar numbers saw temporary use of these medications during their admission. More than half of patients on cholinesterase-inhibitors were taking anticholinergics at the same time on admission, potentially directly counteracting their effects.

Authors+Show Affiliations

Department of Acute Medicine, The Ipswich Hospital NHS Trust, Ipswich, UK.Department of Medicine for the Elderly, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK. Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.Department of Medicine and Rehabilitation, Helsinki University Hospitals, Helsinki, Finland.Department of Acute Medicine, The Ipswich Hospital NHS Trust, Ipswich, UK.Department of Medicine for the Elderly, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK.Department of Acute Medicine, East and North Hertfordshire NHS Trust, Lister Hospital, Stevenage, UK.Department of Acute Medicine, East and North Hertfordshire NHS Trust, Lister Hospital, Stevenage, UK.Department of Acute Medicine, VU University Medical Center, Amsterdam, The Netherlands.Department of Medical-Surgical Sciences and Translational Medicine, University La Sapienza, Rome, Italy.Department of Medical-Surgical Sciences and Translational Medicine, University La Sapienza, Rome, Italy.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

29729025

Citation

Weichert, I, et al. "Anticholinergic Medications in Patients Admitted With Cognitive Impairment or Falls (AMiCI). the Impact of Hospital Admission On Anticholinergic Cognitive Medication Burden. Results of a Multicentre Observational Study." Journal of Clinical Pharmacy and Therapeutics, vol. 43, no. 5, 2018, pp. 682-694.
Weichert I, Romero-Ortuno R, Tolonen J, et al. Anticholinergic medications in patients admitted with cognitive impairment or falls (AMiCI). The impact of hospital admission on anticholinergic cognitive medication burden. Results of a multicentre observational study. J Clin Pharm Ther. 2018;43(5):682-694.
Weichert, I., Romero-Ortuno, R., Tolonen, J., Soe, T., Lebus, C., Choudhury, S., Nadarajah, C. V., Nanayakkara, P., Orrù, M., & Di Somma, S. (2018). Anticholinergic medications in patients admitted with cognitive impairment or falls (AMiCI). The impact of hospital admission on anticholinergic cognitive medication burden. Results of a multicentre observational study. Journal of Clinical Pharmacy and Therapeutics, 43(5), 682-694. https://doi.org/10.1111/jcpt.12694
Weichert I, et al. Anticholinergic Medications in Patients Admitted With Cognitive Impairment or Falls (AMiCI). the Impact of Hospital Admission On Anticholinergic Cognitive Medication Burden. Results of a Multicentre Observational Study. J Clin Pharm Ther. 2018;43(5):682-694. PubMed PMID: 29729025.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic medications in patients admitted with cognitive impairment or falls (AMiCI). The impact of hospital admission on anticholinergic cognitive medication burden. Results of a multicentre observational study. AU - Weichert,I, AU - Romero-Ortuno,R, AU - Tolonen,J, AU - Soe,T, AU - Lebus,C, AU - Choudhury,S, AU - Nadarajah,C V, AU - Nanayakkara,P, AU - Orrù,M, AU - Di Somma,S, AU - ,, Y1 - 2018/05/04/ PY - 2017/09/16/received PY - 2018/02/23/accepted PY - 2018/5/8/pubmed PY - 2018/12/13/medline PY - 2018/5/6/entrez KW - anticholinergic cognitive burden KW - anticholinergics KW - cholinesterase inhibitors KW - cognitive impairment KW - falls KW - medication review KW - medicines optimization SP - 682 EP - 694 JF - Journal of clinical pharmacy and therapeutics JO - J Clin Pharm Ther VL - 43 IS - 5 N2 - WHAT IS KNOWN AND OBJECTIVE: Drugs with anticholinergic properties increase the risk of falls, delirium, chronic cognitive impairment, and mortality and counteract procholinergic medications used in the treatment of dementia. Medication review and optimisation to reduce anticholinergic burden in patients at risk is recommended by specialist bodies. Little is known how effective this review is in patients who present acutely and how often drugs with anticholinergic properties are used temporarily during an admission. The aim of the study was to describe the changes in the anticholinergic cognitive burden (ACB) in patients admitted to hospital with a diagnosis of delirium, chronic cognitive impairment or falls and to look at the temporary use of anticholinergic medications during hospital stay. METHODS: This is a multi-centre observational study that was conducted in seven different hospitals in the UK, Finland, The Netherlands and Italy. RESULTS AND DISCUSSION: 21.1% of patients had their ACB score reduced by a mean of 1.7%, 19.7% had their ACB increased by a mean of 1.6%, 22.8% of DAP naïve patients were discharged on anticholinergic medications. There was no change in the ACB scores in 59.2% of patients. 54.1% of patients on procholinergics were taking anticholinergics. Out of the 98 medications on the ACB scale, only 56 were seen. Medications with a low individual burden were accounting for 64.9% of the total burden. Anticholinergic drugs were used temporarily during the admission in 21.9% of all patients. A higher number of DAPs used temporarily during admission was associated with a higher risk of ACB score increase on discharge (OR = 1.82, 95% CI for OR: 1.36-2.45, P < .001). WHAT IS NEW AND CONCLUSION: There was no reduction in anticholinergic cognitive burden during the acute admissions. This was the same for all diagnostic subgroups. The anticholinergic load was predominantly caused by medications with a low individual burden. More than 1 in 5 patients not taking anticholinergics on admission were discharged on them and similar numbers saw temporary use of these medications during their admission. More than half of patients on cholinesterase-inhibitors were taking anticholinergics at the same time on admission, potentially directly counteracting their effects. SN - 1365-2710 UR - https://www.unboundmedicine.com/medline/citation/29729025/Anticholinergic_medications_in_patients_admitted_with_cognitive_impairment_or_falls__AMiCI___The_impact_of_hospital_admission_on_anticholinergic_cognitive_medication_burden__Results_of_a_multicentre_observational_study_ L2 - https://doi.org/10.1111/jcpt.12694 DB - PRIME DP - Unbound Medicine ER -