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Anticholinergic Burden is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital.
J Am Med Dir Assoc. 2018 11; 19(11):942-947.JA

Abstract

OBJECTIVES

To determine whether anticholinergic burden may predict differently 1-year mortality in older patients discharged from acute care hospitals with or without dependency in basic activities of daily living (BADL).

DESIGN

Prospective observational study.

SETTING AND PARTICIPANTS

Our series consisted of 807 patients aged 65 years or older consecutively discharged from 7 acute care geriatric wards throughout Italy between June 2010 and May 2011.

MEASURES

Overall anticholinergic burden was assessed by the anticholinergic cognitive burden (ACB) score. Dependency was rated by BADL, and dependency in at least 1 BADL was considered as a potential mediator in the analysis. The study outcome was all-cause mortality during 12-months of follow-up.

RESULTS

Patients included in the study were aged 81.0 ± 7.4 years, and 438 (54.3%) were female. During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with dependency in at least 1 BADL [hazard ratio (HR) 2.25 95% confidence (CI) 1.22‒4.14], but not among independent ones (HR 1.06 95% CI 0.50‒2.34). The association was confirmed among dependent patients after adjusting for the number of lost BADL at discharge (HR 2.20 95% CI 1.18‒4.04) or ACB score at 3-month follow-up (HR 2.18 95% CI 1.20‒3.98), as well as when considering ACB score as a continuous variable (HR 1.28 95% CI 1.11‒1.49). The interaction between ACB score at discharge and BADL dependency was highly significant (P < .001).

CONCLUSIONS/IMPLICATIONS

ACB score at discharge may predict mortality among older patients discharged from an acute care hospital carrying at least 1 BADL dependency. Hospital physicians should be aware that prescribing anticholinergic medications in this population may have negative prognostic implications and they should try to reduce anticholinergic burden at discharge whenever possible.

Authors+Show Affiliations

Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy.Department of Gerontology, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Gemelli University Hospital, Rome, Italy.Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy.Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy.Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy.Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy.Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy.Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy.Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy.Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy.Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy. Electronic address: a.corsonello@inrca.it.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

30049542

Citation

Lattanzio, Fabrizia, et al. "Anticholinergic Burden Is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital." Journal of the American Medical Directors Association, vol. 19, no. 11, 2018, pp. 942-947.
Lattanzio F, Onder G, La Fauci MM, et al. Anticholinergic Burden is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital. J Am Med Dir Assoc. 2018;19(11):942-947.
Lattanzio, F., Onder, G., La Fauci, M. M., Volpato, S., Cherubini, A., Fabbietti, P., Ruggiero, C., Garasto, S., Cozza, A., Crescibene, L., Tarsitano, A., & Corsonello, A. (2018). Anticholinergic Burden is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital. Journal of the American Medical Directors Association, 19(11), 942-947. https://doi.org/10.1016/j.jamda.2018.06.012
Lattanzio F, et al. Anticholinergic Burden Is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital. J Am Med Dir Assoc. 2018;19(11):942-947. PubMed PMID: 30049542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticholinergic Burden is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital. AU - Lattanzio,Fabrizia, AU - Onder,Graziano, AU - La Fauci,Mattia Miriam, AU - Volpato,Stefano, AU - Cherubini,Antonio, AU - Fabbietti,Paolo, AU - Ruggiero,Carmelinda, AU - Garasto,Sabrina, AU - Cozza,Annalisa, AU - Crescibene,Lucia, AU - Tarsitano,Assunta, AU - Corsonello,Andrea, Y1 - 2018/07/23/ PY - 2018/04/20/received PY - 2018/06/06/revised PY - 2018/06/11/accepted PY - 2018/7/28/pubmed PY - 2019/11/20/medline PY - 2018/7/28/entrez KW - Anticholinergic burden KW - disability KW - mortality SP - 942 EP - 947 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 19 IS - 11 N2 - OBJECTIVES: To determine whether anticholinergic burden may predict differently 1-year mortality in older patients discharged from acute care hospitals with or without dependency in basic activities of daily living (BADL). DESIGN: Prospective observational study. SETTING AND PARTICIPANTS: Our series consisted of 807 patients aged 65 years or older consecutively discharged from 7 acute care geriatric wards throughout Italy between June 2010 and May 2011. MEASURES: Overall anticholinergic burden was assessed by the anticholinergic cognitive burden (ACB) score. Dependency was rated by BADL, and dependency in at least 1 BADL was considered as a potential mediator in the analysis. The study outcome was all-cause mortality during 12-months of follow-up. RESULTS: Patients included in the study were aged 81.0 ± 7.4 years, and 438 (54.3%) were female. During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with dependency in at least 1 BADL [hazard ratio (HR) 2.25 95% confidence (CI) 1.22‒4.14], but not among independent ones (HR 1.06 95% CI 0.50‒2.34). The association was confirmed among dependent patients after adjusting for the number of lost BADL at discharge (HR 2.20 95% CI 1.18‒4.04) or ACB score at 3-month follow-up (HR 2.18 95% CI 1.20‒3.98), as well as when considering ACB score as a continuous variable (HR 1.28 95% CI 1.11‒1.49). The interaction between ACB score at discharge and BADL dependency was highly significant (P < .001). CONCLUSIONS/IMPLICATIONS: ACB score at discharge may predict mortality among older patients discharged from an acute care hospital carrying at least 1 BADL dependency. Hospital physicians should be aware that prescribing anticholinergic medications in this population may have negative prognostic implications and they should try to reduce anticholinergic burden at discharge whenever possible. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/30049542/Anticholinergic_Burden_is_Associated_With_Increased_Mortality_in_Older_Patients_With_Dependency_Discharged_From_Hospital_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(18)30332-3 DB - PRIME DP - Unbound Medicine ER -