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Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities.
J Am Med Dir Assoc. 2019 09; 20(9):1156-1162.JA

Abstract

OBJECTIVES

To compare 3 internationally established criteria for drugs with anticholinergic properties (DAPs) and their associated factors in long-term care facilities, and to investigate the association between use of DAPs and psychological well-being (PWB) or mortality.

DESIGN

Cross-sectional study and 1-year follow-up of all-cause mortality.

SETTING AND PARTICIPANTS

Of all 4449 residents living in long-term care facilities in Helsinki in 2011, 2432 (≥65 years of age) participated after exclusion of residents with severe dementia.

MEASUREMENTS

Data on demographics, medication use, and active diagnoses were collected by trained staff using structured questionnaires. DAP use was defined by the following 3 international criteria: Chew's list, the Anticholinergic Risk Scale, and the Anticholinergic Drug Scale. The total number of DAPs was counted and referred to as anticholinergic burden. PWB was assessed by a questionnaire and yielded a score ranging from 0 to 1. Mortality data was retrieved from central registers.

RESULTS

Of all participants, 85% were DAP users according to at least 1 of the 3 criteria used. Overlap between the 3 criteria was only moderate. DAP users were younger and a larger proportion of them had better cognition. However, they suffered more often from depression and other psychiatric diagnoses than nonusers. DAP users had lower PWB scores than those not using DAPs, and PWB decreased linearly in the overlapping groups from nonusers to those using DAPs according to all 3 criteria. The total number of DAPs used predicted mortality.

CONCLUSIONS AND IMPLICATIONS

DAP use and PWB appear to be negatively associated. When combining several criteria of DAPs, their burden predicted mortality. Clinicians should carefully consider the potential benefits and harms when prescribing DAPs to older persons.

Authors+Show Affiliations

Department of General Practice, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland. Electronic address: ulla.aalto@fimnet.fi.Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland.Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland.Department of General Practice, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland.Department of General Practice, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland.Department of General Practice, University of Helsinki, Helsinki, Finland; Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30910551

Citation

Aalto, Ulla L., et al. "Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities." Journal of the American Medical Directors Association, vol. 20, no. 9, 2019, pp. 1156-1162.
Aalto UL, Finne-Soveri H, Kautiainen H, et al. Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities. J Am Med Dir Assoc. 2019;20(9):1156-1162.
Aalto, U. L., Finne-Soveri, H., Kautiainen, H., Roitto, H. M., Öhman, H., & Pitkälä, K. H. (2019). Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities. Journal of the American Medical Directors Association, 20(9), 1156-1162. https://doi.org/10.1016/j.jamda.2019.02.007
Aalto UL, et al. Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities. J Am Med Dir Assoc. 2019;20(9):1156-1162. PubMed PMID: 30910551.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities. AU - Aalto,Ulla L, AU - Finne-Soveri,Harriet, AU - Kautiainen,Hannu, AU - Roitto,Hanna-Maria, AU - Öhman,Hannareeta, AU - Pitkälä,Kaisu H, Y1 - 2019/03/23/ PY - 2018/10/08/received PY - 2019/01/28/revised PY - 2019/02/03/accepted PY - 2019/3/27/pubmed PY - 2020/11/12/medline PY - 2019/3/27/entrez KW - Anticholinergic drug KW - aged KW - anticholinergic burden KW - mortality KW - psychological well-being SP - 1156 EP - 1162 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 20 IS - 9 N2 - OBJECTIVES: To compare 3 internationally established criteria for drugs with anticholinergic properties (DAPs) and their associated factors in long-term care facilities, and to investigate the association between use of DAPs and psychological well-being (PWB) or mortality. DESIGN: Cross-sectional study and 1-year follow-up of all-cause mortality. SETTING AND PARTICIPANTS: Of all 4449 residents living in long-term care facilities in Helsinki in 2011, 2432 (≥65 years of age) participated after exclusion of residents with severe dementia. MEASUREMENTS: Data on demographics, medication use, and active diagnoses were collected by trained staff using structured questionnaires. DAP use was defined by the following 3 international criteria: Chew's list, the Anticholinergic Risk Scale, and the Anticholinergic Drug Scale. The total number of DAPs was counted and referred to as anticholinergic burden. PWB was assessed by a questionnaire and yielded a score ranging from 0 to 1. Mortality data was retrieved from central registers. RESULTS: Of all participants, 85% were DAP users according to at least 1 of the 3 criteria used. Overlap between the 3 criteria was only moderate. DAP users were younger and a larger proportion of them had better cognition. However, they suffered more often from depression and other psychiatric diagnoses than nonusers. DAP users had lower PWB scores than those not using DAPs, and PWB decreased linearly in the overlapping groups from nonusers to those using DAPs according to all 3 criteria. The total number of DAPs used predicted mortality. CONCLUSIONS AND IMPLICATIONS: DAP use and PWB appear to be negatively associated. When combining several criteria of DAPs, their burden predicted mortality. Clinicians should carefully consider the potential benefits and harms when prescribing DAPs to older persons. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/30910551/Use_of_Anticholinergic_Drugs_According_to_Various_Criteria_and_Their_Association_With_Psychological_Well_Being_and_Mortality_in_Long_Term_Care_Facilities_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(19)30233-6 DB - PRIME DP - Unbound Medicine ER -