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Huh Y, Kim YJ, Choi JY, Lee JE, Jung HW, Shin CM, Won CW, Son KY. Comparison of anticholinergic burden with chronic polypharmacy on functional decline and mortality in Korean older people: a retrospective nationwide cohort study. BMC Geriatr 2024; 24:90. [PMID: 38262951 PMCID: PMC10807110 DOI: 10.1186/s12877-024-04692-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND We aimed to evaluate the association of anticholinergic burden and chronic polypharmacy with the incidence of functional decline and all-cause mortality, and to determine the difference between anticholinergic burden and chronic polypharmacy among Korean older people. METHODS This nationwide cohort study included 42,132 older people aged ≥ 65 years who underwent Korean National Health Insurance Service health examinations from 2007 to 2008. Odds ratios (ORs) and 95% confidence intervals (CIs) for abnormal Timed Up and Go (TUG) test results were assessed using multivariate logistic regression analyses. Hazard ratios (HRs) and 95% CIs for all-cause mortality until the end of 2015 were estimated using multivariable Cox proportional hazards regression analysis. RESULTS Of the participants, 37.19% had abnormal TUG test results, and 7.66% of those died during the 5.7-year mean follow-up. The abnormal TUG test results OR increased by 27% among individuals with Korean Anticholinergic Burden Scale (KABS) scores ≥ 3 (OR 1.27, 95% CI 1.02-1.58) compared to those with KABS scores of 0. The HRs for all-cause mortality increased for individuals with higher KABS scores (P for trend < 0.001) or chronic polypharmacy (P for trend < 0.001) compared to those for individuals without these conditions. The combination of a higher KABS or chronic polypharmacy and abnormal TUG test results increased the risk of all-cause mortality (All P for trend < 0.001). CONCLUSION Anticholinergic drug burden shows a better association with functional decline than chronic polypharmacy, and the use of medications and functional decline may be important risk factors for all-cause mortality among older people.
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Affiliation(s)
- Youn Huh
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji University, Gyeonggi-do, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ji Eun Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ki Young Son
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, 05505, Seoul, Korea.
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Espaulella-Ferrer M, Molist-Brunet N, Espaulella-Panicot J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Otero-Viñas M. Medication Assessment in an Older Population during Acute Care Hospitalization and Its Effect on the Anticholinergic Burden: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5322. [PMID: 37047938 PMCID: PMC10094232 DOI: 10.3390/ijerph20075322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
(1) Background: Anticholinergic and sedative drugs (ASDs) contribute to negative health outcomes, especially in the frail population. In this study, we aimed to assess whether frailty increases with anticholinergic burden and to evaluate the effects of medication reviews (MRs) on ASD regimens among patients attending an acute care for the elderly (ACE) unit. (2) Methods: A cohort study was conducted between June 2019 and October 2020 with 150 consecutive patients admitted to our ACE unit. Demographic, clinical, and pharmacological data were assessed. Frailty score was determined using the Frail-VIG index (FI-VIG), and ASD burden was quantified using the drug burden index (DBI). In addition, the MR was performed using the patient-centered prescription (PCP) model. We used a paired T-test to compare the DBI pre- and post-MR and univariate and multivariate regression to identify the factors associated with frailty. (3) Results: Overall, 85.6% (n = 128) of participants showed some degree of frailty (FI-VIG > 0.20) and 84% (n = 126) of patients received treatment with ASDs upon admission (pre-MR). As the degree of frailty increased, so did the DBI (p < 0.001). After the implementation of the MR through the application of the PCP model, a reduction in the DBI was noted (1.06 ± 0.8 versus 0.95 ± 0.7) (p < 0.001). After adjusting for covariates, the association between frailty and the DBI was apparent (OR: 11.42, 95% (CI: 2.77-47.15)). (4) Conclusions: A higher DBI was positively associated with frailty. The DBI decreased significantly in frail patients after a personalized MR. Thus, MRs focusing on ASDs are crucial for frail older patients.
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Affiliation(s)
- Mariona Espaulella-Ferrer
- Servei Territorial de Geriatria i Cures Pal·Liatives d’Osona i el Ripollés, Hospital Universitari de la Santa Creu de Vic, Hospital Universitari de Vic, 08500 Vic, Spain
- Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Nuria Molist-Brunet
- Servei Territorial de Geriatria i Cures Pal·Liatives d’Osona i el Ripollés, Hospital Universitari de la Santa Creu de Vic, Hospital Universitari de Vic, 08500 Vic, Spain
- Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Joan Espaulella-Panicot
- Servei Territorial de Geriatria i Cures Pal·Liatives d’Osona i el Ripollés, Hospital Universitari de la Santa Creu de Vic, Hospital Universitari de Vic, 08500 Vic, Spain
- Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | | | - Emma Puigoriol-Juvanteny
- Epidemiology Department, Hospital Universitari de Vic, 08500 Vic, Spain
- Multidisciplinary Inflamations Research Group (MIRG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Marta Otero-Viñas
- Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
- Faculty of Science, Technology and Engineering, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
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ÇAVUŞOĞLU Ç. Inappropriate drug use determined by TIME criteria and the relation with frailty. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1136024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Çalışmamızın amacı kırılganlık ile çoklu ilaç kullanımı, Potansiyel Uygunsuz İlaç Kullanımı (PUİK) ve Potansiyel Reçete İhmali (PRİ) ilişkisini değerlendirmektedir.
Gereç ve Yöntem: Geriatri polikliniğine 1 Ekim 2021 ve 1 Nisan 2022 ayaktan başvuran 65 yaş ve üzeri hastalar retrospektif değerlendirildi. Hastaların demografik verileri, kullandıkları ilaçların etken maddeleri, komorbid hastalıkları ve Klinik Kırılganlık Skalası (KKS) skoru kayıt edildi. KKS skoruna göre hastalar kırılgan ve kırılgan olmayan olarak ikiye ayrıldı. Turkish Inappropriate Medication use in the Elderly (TIME) to STOP kriterleri PUİK değerlendirmek için, TIME to START ise PRİ’yi belirlemek için kullanıldı.
Bulgular: Hastaların ortalama yaşı 75,9±8,7 olup, hastaların %63,1 kadın idi. Hastaların kullandığı ortanca ilaç sayısı 7 (0-17) iken, katılımcıların %79,6’sında polifarmasi mevcuttu. Kırılgan hastaların %69,5 (n=42)’ inde polifarmasi mevcut olup, kırılgan olmayan hastalarda bu oran %22,5 (n=18) idi. Kırılgan hastalarda oral beslenme ürünü, 3-hidroksi-3-metil-glutaril-KoA reduktaz inhibitörleri ve demans tedavisi reçete ihmali oranı anlamlı olarak normal popülasyondan daha fazla idi. Proton pompa inhibitörleri, antipsikotikler, asetilsalisilik asit ve betahistinin uygunsuz kullanım oranı kırılgan hastalarda, kırılgan olmayan hastalardan daha fazla idi.
Sonuç: Polifarmasi, PRİ ve PUİK hastalarda değerlendirilirken kırılganlık göz önünde bulundurulmalıdır ve her ülkenin farklı reçeteleme alışkanlığı olmasından dolayı ülkemize özel olan TIME kriterlerinin kullanımı önemli bir avantaj sağlayabilir.
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Affiliation(s)
- Çağatay ÇAVUŞOĞLU
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ŞANLIURFA MEHMET AKİF İNAN SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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Luo J, Liao X, Zou C, Zhao Q, Yao Y, Fang X, Spicer J. Identifying Frail Patients by Using Electronic Health Records in Primary Care: Current Status and Future Directions. Front Public Health 2022; 10:901068. [PMID: 35812471 PMCID: PMC9256951 DOI: 10.3389/fpubh.2022.901068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022] Open
Abstract
With the rapidly aging population, frailty, characterized by an increased risk of adverse outcomes, has become a major public health problem globally. Several frailty guidelines or consensuses recommend screening for frailty, especially in primary care settings. However, most of the frailty assessment tools are based on questionnaires or physical examinations, adding to the clinical workload, which is the major obstacle to converting frailty research into clinical practice. Medical data naturally generated by routine clinical work containing frailty indicators are stored in electronic health records (EHRs) (also called electronic health record (EHR) data), which provide resources and possibilities for frailty assessment. We reviewed several frailty assessment tools based on primary care EHRs and summarized the features and novel usage of these tools, as well as challenges and trends. Further research is needed to develop and validate frailty assessment tools based on EHRs in primary care in other parts of the world.
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Affiliation(s)
- Jianzhao Luo
- International Medical Centre/Ward of General Practice and National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- International Medical Centre/Ward of General Practice and National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiaoyang Liao ; orcid.org/0000000344099674
| | - Chuan Zou
- Department of General Practice, Chengdu Fifth People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Zhao
- International Medical Centre/Ward of General Practice and National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Qian Zhao ; orcid.org/0000000295405726
| | - Yi Yao
- International Medical Centre/Ward of General Practice and National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Fang
- International Medical Centre/Ward of General Practice and National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - John Spicer
- GP and Senior Lecturer in Medical Law and Clinical Ethics, Institute of Medical and Biomedical Education, St George's University of London, London, United Kingdom
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Shwe PS, Thein PM, Marwaha P, Taege K, Shankumar R, Junckerstorff R. Anticholinergic burden and poor oral health are associated with frailty in geriatric patients undergoing inpatient rehabilitation: A cross-sectional study. Gerodontology 2022; 40:213-219. [PMID: 35477932 DOI: 10.1111/ger.12635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poor oral health is known to be associated with frailty in geriatric populations. Recent exposure to anticholinergic medications is responsible for features of poor oral health. Anticholinergic medications pose a cumulative risk for frailty. METHODS We studied 115 geriatric inpatients (aged >65 years and recruited over a 3-month period from October to December 2017). Patients who were severely agitated, cognitively impaired, from a non-English speaking background and with severe sensory impairment were excluded. Frailty and oral health were assessed using the Reported Edmonton Frailty Scale and the Oral Health Assessment Test, respectively. Exposure to anticholinergic medications was assessed using the Anticholinergic Burden Scale. RESULTS The mean age was 80 (range from 66 to 101). Only 44 patients (38.3%) were not exposed to any anticholinergic medication. Nearly two-thirds of patients were taking anticholinergic medications, with 25% classified as having a high anticholinergic burden (ACB ≥ 4). Approximately one-third of severely frail patients were exposed to a high anticholinergic burden. Patients with a high anticholinergic burden were more than twice as likely to have severe frailty (OR 2.21; 95% confidence interval 1.05-4.6). Poor oral health was associated with frailty (OR 1.24; 95% CI 1.02-1.49). CONCLUSION High anticholinergic burden was found to be a risk marker for severe frailty independent of its effect on oral health. Poor oral health was associated with all levels of frailty. This study highlights a need for a review of medications with anticholinergic properties in older patients. Further research should be directed at whether deprescribing could prevent poor oral health or slow the progression of frailty.
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Affiliation(s)
- Phu S Shwe
- Monash Ageing Research Centre (MONARC), Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Paul M Thein
- Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Parul Marwaha
- Department of Dental Services, Monash Health, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Karina Taege
- Department of Pharmacy, Monash Health, Melbourne, Victoria, Australia
| | - Ramini Shankumar
- Monash University, Melbourne, Victoria, Australia.,Department of Dental Services, Monash Health, Melbourne, Victoria, Australia
| | - Ralph Junckerstorff
- Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
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