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Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study.
Drugs Aging. 2019 03; 36(3):289-297.DA

Abstract

BACKGROUND

It is not known whether drugs with different anticholinergic ratings contribute proportionately to overall anticholinergic score.

OBJECTIVES

Our objective was to assess the risk of falls or fall-related injuries as a function of the overall anticholinergic score resulting from drugs with different anticholinergic ratings among people with impaired cognition.

METHODS

This was a retrospective cohort study of adults aged ≥ 65 years with mild cognitive impairment (MCI) or dementia and two or more additional chronic conditions (N = 10,698) in an integrated delivery system. Electronic health record data, including pharmacy fills and diagnosis claims, were used to assess anticholinergic medication use, quantified using the anticholinergic cognitive burden (ACB) scale, falls and fall-related injuries.

RESULTS

During a median follow-up of 366 days, 63% of the cohort used one or more ACB drug; 2015 (18.8%) people experienced a fall or fall-related injury. Among patients with a daily ACB score of 5, the greatest increase in risk of falls or fall-related injuries was seen when level 2 and level 3 drugs were used in combination [hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.51-2.83]. Multiple ACB level 1 drugs taken together also increased the hazard of a fall or fall-related injury (HR 1.16; 95% CI 1.03-1.32). The risk of fall or fall-related injury as a function of exposure to ACB level 2 drugs (HR 1.56; 95% CI 1.16-2.10) was higher than that for ACB level 1 or 3 drugs.

CONCLUSIONS

The same daily ACB score was associated with a different degree of risk, depending on the ACB ratings of the individual drugs comprising the score. Combinations of level 2 and level 3 drugs had the greatest risk of fall or fall-related injury relative to other individuals with the same daily ACB score. Low-potency anticholinergic drugs taken together modestly increased the hazard of a fall or fall-related injury.

Authors+Show Affiliations

Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th Floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA. ariel@jhmi.edu.Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA.Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA. Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA. University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th Floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA. cyboyd@jhmi.edu. Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. cyboyd@jhmi.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30652263

Citation

Green, Ariel R., et al. "Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury Among Older Adults With Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: a Retrospective Cohort Study." Drugs & Aging, vol. 36, no. 3, 2019, pp. 289-297.
Green AR, Reifler LM, Bayliss EA, et al. Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study. Drugs Aging. 2019;36(3):289-297.
Green, A. R., Reifler, L. M., Bayliss, E. A., Weffald, L. A., & Boyd, C. M. (2019). Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study. Drugs & Aging, 36(3), 289-297. https://doi.org/10.1007/s40266-018-00630-z
Green AR, et al. Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury Among Older Adults With Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: a Retrospective Cohort Study. Drugs Aging. 2019;36(3):289-297. PubMed PMID: 30652263.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study. AU - Green,Ariel R, AU - Reifler,Liza M, AU - Bayliss,Elizabeth A, AU - Weffald,Linda A, AU - Boyd,Cynthia M, PY - 2019/1/18/pubmed PY - 2019/4/24/medline PY - 2019/1/18/entrez SP - 289 EP - 297 JF - Drugs & aging JO - Drugs Aging VL - 36 IS - 3 N2 - BACKGROUND: It is not known whether drugs with different anticholinergic ratings contribute proportionately to overall anticholinergic score. OBJECTIVES: Our objective was to assess the risk of falls or fall-related injuries as a function of the overall anticholinergic score resulting from drugs with different anticholinergic ratings among people with impaired cognition. METHODS: This was a retrospective cohort study of adults aged ≥ 65 years with mild cognitive impairment (MCI) or dementia and two or more additional chronic conditions (N = 10,698) in an integrated delivery system. Electronic health record data, including pharmacy fills and diagnosis claims, were used to assess anticholinergic medication use, quantified using the anticholinergic cognitive burden (ACB) scale, falls and fall-related injuries. RESULTS: During a median follow-up of 366 days, 63% of the cohort used one or more ACB drug; 2015 (18.8%) people experienced a fall or fall-related injury. Among patients with a daily ACB score of 5, the greatest increase in risk of falls or fall-related injuries was seen when level 2 and level 3 drugs were used in combination [hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.51-2.83]. Multiple ACB level 1 drugs taken together also increased the hazard of a fall or fall-related injury (HR 1.16; 95% CI 1.03-1.32). The risk of fall or fall-related injury as a function of exposure to ACB level 2 drugs (HR 1.56; 95% CI 1.16-2.10) was higher than that for ACB level 1 or 3 drugs. CONCLUSIONS: The same daily ACB score was associated with a different degree of risk, depending on the ACB ratings of the individual drugs comprising the score. Combinations of level 2 and level 3 drugs had the greatest risk of fall or fall-related injury relative to other individuals with the same daily ACB score. Low-potency anticholinergic drugs taken together modestly increased the hazard of a fall or fall-related injury. SN - 1179-1969 UR - https://www.unboundmedicine.com/medline/citation/30652263/Drugs_Contributing_to_Anticholinergic_Burden_and_Risk_of_Fall_or_Fall_Related_Injury_among_Older_Adults_with_Mild_Cognitive_Impairment_Dementia_and_Multiple_Chronic_Conditions:_A_Retrospective_Cohort_Study_ L2 - https://dx.doi.org/10.1007/s40266-018-00630-z DB - PRIME DP - Unbound Medicine ER -