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Tazaki T, Yamada H, Sato R, Ishii H, Sugita S, Yanagihara H, Nakamura D, Takashio O, Inamoto A, Iwanami A. Constipation-associated factors in outpatients with schizophrenia: A multicenter questionnaire survey. Neuropsychopharmacol Rep 2024. [PMID: 38957048 DOI: 10.1002/npr2.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 07/04/2024] Open
Abstract
Constipation is a prevalent gastrointestinal disorder that affects people globally, decreasing their quality of life and life expectancy. Individuals with schizophrenia often suffer from constipation, which could be a result of the illness itself or the side effects of psychotropic medications. However, little research has been conducted on factors contributing to constipation in individuals with schizophrenia. To address this issue, we conducted a survey using self-administered questionnaires and medical records to identify factors associated with constipation in psychiatric outpatients. This study included 399 patients with schizophrenia, resulting in a high prevalence of constipation (43.4%). The analysis suggested that female gender, the doses of antiparkinsonian medications, and benzodiazepine sleeping pills may be associated with constipation.
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Affiliation(s)
- Taro Tazaki
- Department of Psychiatry, Graduate School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Showa University Karasuyama Hospital, Tokyo, Japan
| | - Hiroki Yamada
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University Northern Yokohama Hospital, Tokyo, Japan
- Shinrin Koen Mental Clinic, Tokyo, Japan
| | - Ryotaro Sato
- Department of Psychiatry, Graduate School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University East Hospital, Tokyo, Japan
| | - Hiroki Ishii
- Department of Psychiatry, Graduate School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University East Hospital, Tokyo, Japan
| | - Shutaro Sugita
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Showa University Karasuyama Hospital, Tokyo, Japan
| | - Haruka Yanagihara
- Department of Psychiatry, Graduate School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University East Hospital, Tokyo, Japan
| | - Dan Nakamura
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Showa University Karasuyama Hospital, Tokyo, Japan
| | - Osamu Takashio
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University East Hospital, Tokyo, Japan
| | - Atsuko Inamoto
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Department of Psychiatry, Showa University Northern Yokohama Hospital, Tokyo, Japan
| | - Akira Iwanami
- Department of Psychiatry, School of Medicine, Showa University, Tokyo, Japan
- Showa University Karasuyama Hospital, Tokyo, Japan
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Gebreyohannes EA, Taye WA, Shibe BS, Ayele EM, Lee K, Mengistu SB, Soiza RL, Myint PK, Abdela OA. Anticholinergic burden among in-patients: a cross-sectional study on prevalence, determinants, and impact on mortality in Ethiopia. Ther Adv Drug Saf 2024; 15:20420986241259624. [PMID: 38881539 PMCID: PMC11179449 DOI: 10.1177/20420986241259624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Background Numerous studies report that anticholinergic burden (ACB) has been linked with several health consequences, including increased hospital admissions, prolonged hospitalization, and physical and cognitive impairment. However, low- and middle-income settings, as well as younger individuals, are underrepresented. Objectives To assess the prevalence and determinants of ACB, and to assess the impact of ACB on in-hospital mortality among adult in-patients at University of Gondar Comprehensive Specialized Hospital (UOGCSH). Design A cross-sectional study was conducted from June to August 2022 at UOGCSH among adult in-patients. Methods A pre-tested questionnaire was utilized to collect data from patients and their corresponding medical charts. A consecutive sampling technique was used to select the participants. Descriptive statistics were used to summarize socio-demographic and clinical characteristics. Chi-squared, Fisher's exact, and Wilcoxon rank sum tests, as appropriate, were used to determine associations between independent variables and ACB. Kaplan-Meier survival curve and Cox proportional hazards regression test were used to assess the impact of ACB on in-hospital mortality. Results A total of 420 adult in-patients, median (interquartile range) age of 38 (26, 55) years, participated in this study. Over half (58.3%) were exposed to anticholinergic medicines, with a high ACB (⩾3) seen in 11.2% of participants. High ACB was associated with higher median number of medicines per patient (p = 0.003) higher median hospital length of stay (p = 0.033), and having mental and behavioral disorders (p < 0.001). No significant association was found between ACB and in-hospital mortality (log-rank test p = 0.26, Cox regression adjusted hazard ratio: 1.47, 95% CI: 0.335-6.453, p = 0.61). Conclusion Among adult in-patients, a significant majority (58.3%) were subjected to medications possessing anticholinergic properties, with a noteworthy 11.2% of the study subjects exhibiting a high ACB. Participants with higher median length of hospital stay were more likely to have high ACB even in this relatively younger adult patient population.
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Affiliation(s)
- Eyob Alemayehu Gebreyohannes
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, City East Campus, Frome Road, Adelaide, SA 5000, Australia
- School of Allied Health, The University of Western Australia, Perth, WA, Australia
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Wagaye Atalay Taye
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Biniam Siyum Shibe
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Emneteab Mesfin Ayele
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Kenneth Lee
- School of Allied Health, The University of Western Australia, Perth, WA, Australia
| | | | - Roy Louis Soiza
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Phyo Kyaw Myint
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ousman Abubeker Abdela
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
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Zuleta M, San-José A, Gozalo I, Sánchez-Arcilla M, Carrizo G, Alvarado M, Pérez-Bocanegra C. Patterns of inappropriate prescribing and clinical characteristics in patients at admission to an acute care of the elderly unit. Eur J Clin Pharmacol 2024; 80:553-561. [PMID: 38265499 DOI: 10.1007/s00228-024-03627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Inappropriate prescribing (IP) is common among the elderly and is associated with adverse health outcomes. The role of different patterns of IP in clinical practice remains unclear. The aim of this study is to analyse the characteristics of different patterns of IP in hospitalized older adults. METHODS This is a prospective observational study conducted in the acute care of elderly (ACE) unit of an acute hospital in Barcelona between June and August 2021. Epidemiological and demographic data were collected, and a comprehensive geriatric assessment (CGA) was performed on admitted patients. Four patterns of inappropriate prescribing were identified: extreme polypharmacy (10 or more drugs), potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs) and anticholinergic burden. RESULTS Among 93 admitted patients (51.6% male, mean age of 82.83), the main diagnosis was heart failure (36.6%). Overprescribing patterns (extreme polypharmacy, PIMs, PPOs and anticholinergic burden) were associated with higher comorbidity, increased dependence on instrumental activities of daily living (IADL) and greater prevalence of dementia. Underprescribing (omissions) was associated with important comorbidity, residence in nursing homes, an increased risk of malnutrition, higher social risk and greater frailty. Comparing different patterns of IP, patients with high anticholinergic burden exhibited more extreme polypharmacy and PIMs. In the case of omissions, no association was identified with other IP patterns. CONCLUSIONS We found statistically significant association between patterns of inappropriate prescribing and clinical and CGA variables such as comorbidity, dependency, dementia or frailty. There is a statistically significant association between patterns of overprescribing among patients admitted to the ACE unit.
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Affiliation(s)
- Mónica Zuleta
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain.
| | - Antonio San-José
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
| | - Inés Gozalo
- Pharmacy Department, Sant Rafael Hospital, Barcelona, Spain
| | | | - Gabriela Carrizo
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
| | - Marcelo Alvarado
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
| | - Carmen Pérez-Bocanegra
- Geriatric Unit, Internal Medicine Department, Vall d'Hebron Hospital, 08035, Barcelona, Spain
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Liu BM, Kouladjian O'Donnell L, Redston MR, Fujita K, Thillainadesan J, Gnjidic D, Hilmer SN. Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review. J Am Geriatr Soc 2024; 72:589-603. [PMID: 38006299 DOI: 10.1111/jgs.18691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The Drug Burden Index (DBI) measures an individual's total exposure to anticholinergic and sedative medications. This systematic review aimed to investigate the association of the DBI with clinical and prescribing outcomes in observational pharmaco-epidemiological studies, and the effect of DBI exposure on functional outcomes in pre-clinical models. METHODS A systematic search of nine electronic databases, citation indexes and gray literature was performed (April 1, 2007-December 31, 2022). Studies that reported primary data on the association of the DBI with clinical or prescribing outcomes conducted in any setting in humans aged ≥18 years or animals were included. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools and the Systematic Review Centre for Laboratory animal Experimentation risk of bias tool. RESULTS Of 2382 studies screened, 70 met the inclusion criteria (65 in humans, five in animals). In humans, outcomes reported included function (n = 56), cognition (n = 20), falls (n = 14), frailty (n = 7), mortality (n = 9), quality of life (n = 8), hospitalization (n = 7), length of stay (n = 5), readmission (n = 1), other clinical outcomes (n = 15) and prescribing outcomes (n = 2). A higher DBI was significantly associated with increased falls (11/14, 71%), poorer function (31/56, 55%), and cognition (11/20, 55%) related outcomes. Narrative synthesis was used due to significant heterogeneity in the study population, setting, study type, definition of DBI, and outcome measures. Results could not be pooled due to heterogeneity. In animals, outcomes reported included function (n = 18), frailty (n = 2), and mortality (n = 1). In pre-clinical studies, a higher DBI caused poorer function and frailty. CONCLUSIONS A higher DBI may be associated with an increased risk of falls and decreased function and cognition. Higher DBI was inconsistently associated with increased mortality, length of stay, frailty, hospitalization or reduced quality of life. Human observational findings with respect to functional outcomes are supported by preclinical interventional studies. The DBI may be used as a tool to identify older adults at higher risk of harm.
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Affiliation(s)
- Bonnie M Liu
- Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia
- Aged Care Department, Royal North Shore Hospital, Sydney, Australia
| | - Lisa Kouladjian O'Donnell
- Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia
| | - Mitchell R Redston
- St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kenji Fujita
- Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia
| | - Janani Thillainadesan
- Department of Geriatric Medicine and Centre for Education and Research on Ageing, Concord Hospital, Sydney, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sarah N Hilmer
- Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia
- Aged Care Department, Royal North Shore Hospital, Sydney, Australia
- Clinical Pharmacology Department, Royal North Shore Hospital, Sydney, Australia
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Huang YT, Steptoe A, Wei L, Zaninotto P. The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing. BMC Med 2021; 19:321. [PMID: 34911547 PMCID: PMC8675465 DOI: 10.1186/s12916-021-02192-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/18/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Polypharmacy is common among older people and is associated with an increased mortality risk. However, little is known about whether the mortality risk is related to specific medications among older adults with polypharmacy. This study therefore aimed to investigate associations between high-risk medications and all-cause and cause-specific mortality among older adults with polypharmacy. METHODS This study included 1356 older adults with polypharmacy (5+ long-term medications a day for conditions or symptoms) from Wave 6 (2012/2013) of the English Longitudinal Study of Ageing. First, using the agglomerative hierarchical clustering method, participants were grouped according to the use of 14 high-risk medication categories. Next, the relationship between the high-risk medication patterns and all-cause and cause-specific mortality (followed up to April 2018) was examined. All-cause mortality was assessed by Cox proportional hazards model and competing-risk regression was employed for cause-specific mortality. RESULTS Five high-risk medication patterns-a renin-angiotensin-aldosterone system (RAAS) inhibitors cluster, a mental health drugs cluster, a central nervous system (CNS) drugs cluster, a RAAS inhibitors and antithrombotics cluster, and an antithrombotics cluster-were identified. The mental health drugs cluster showed increased risks of all-cause (HR = 1.55, 95%CI = 1.05, 2.28) and cardiovascular disease (CVD) (SHR = 2.11, 95%CI = 1.10, 4.05) mortality compared with the CNS drug cluster over 6 years, while others showed no differences in mortality. Among these patterns, the mental health drugs cluster showed the highest prevalence of antidepressants (64.1%), benzodiazepines (10.4%), antipsychotics (2.4%), antimanic agents (0.7%), opioids (33.2%), and muscle relaxants (21.5%). The findings suggested that older adults with polypharmacy who took mental health drugs (primarily antidepressants), opioids, and muscle relaxants were at higher risk of all-cause and CVD mortality, compared with those who did not take these types of medications. CONCLUSIONS This study supports the inclusion of opioids in the current guidance on structured medication reviews, but it also suggests that older adults with polypharmacy who take psychotropic medications and muscle relaxants are prone to adverse outcomes and therefore may need more attention. The reinforcement of structured medication reviews would contribute to early intervention in medication use which may consequently reduce medication-related problems and bring clinical benefits to older adults with polypharmacy.
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Affiliation(s)
- Yun-Ting Huang
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Lisibach A, Gallucci G, Beeler PE, Csajka C, Lutters M. High anticholinergic burden at admission associated with in-hospital mortality in older patients: A comparison of 19 different anticholinergic burden scales. Basic Clin Pharmacol Toxicol 2021; 130:288-300. [PMID: 34837340 PMCID: PMC9299782 DOI: 10.1111/bcpt.13692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 01/16/2023]
Abstract
Although no gold standard exists to assess a patient's anticholinergic burden, a review identified 19 anticholinergic burden scales (ABSs). No study has yet evaluated whether a high anticholinergic burden measured with all 19 ABSs is associated with in‐hospital mortality and length of stay (LOS). We conducted a cohort study at a Swiss tertiary teaching hospital using patients' electronic health record data from 2015–2018. Included were patients aged ≥65 years, hospitalised ≥48 h without stays and >24 h in intensive care. Patients' cumulative anticholinergic burden score was classified using a binary (<3: low, ≥3: high) and categorical approach (0: no, 0.5–3: low, ≥3: high). In‐hospital mortality and LOS were analysed using multivariable logistic and linear regression, respectively. We included 27,092 patients (mean age 78.0 ± 7.5 years, median LOS 6 days). Of them, 913 died. Depending on the evaluated ABS, 1370 to 17,035 patients were exposed to anticholinergics. Patients with a high burden measured by all 19 ABSs were associated with a 1.32‐ to 3.03‐fold increase in in‐hospital mortality compared with those with no/low burden. We obtained similar results for LOS. To conclude, discontinuing drugs with anticholinergic properties (score ≥3) at admission might be a targeted intervention to decrease in‐hospital mortality and LOS.
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Affiliation(s)
- Angela Lisibach
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
| | - Giulia Gallucci
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland
| | - Patrick E Beeler
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
| | - Monika Lutters
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland.,Swiss Federal Institute of Technology, Zurich, Switzerland
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Lockery JE, Broder JC, Ryan J, Stewart AC, Woods RL, Chong TTJ, Cloud GC, Murray A, Rigby JD, Shah R, Storey E, Ward SA, Wolfe R, Reid CM, Collyer TA, Ernst ME. A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults. J Gen Intern Med 2021; 36:1629-1637. [PMID: 33754317 PMCID: PMC8175463 DOI: 10.1007/s11606-020-06550-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Anticholinergic medications may increase risk of dementia and stroke, but prospective studies in healthy older people are lacking. OBJECTIVE Compare risk of incident dementia and stroke by anticholinergic burden among initially healthy older people. DESIGN Prospective cohort study. SETTING Primary care (Australia and USA). PARTICIPANTS 19,114 community-dwelling participants recruited for the ASPREE trial, aged 70+ years (65+ if US minorities) without major cardiovascular disease, dementia diagnosis, or Modified Mini-Mental State Examination score below 78/100. MEASUREMENTS Baseline anticholinergic exposure was calculated using the Anticholinergic Cognitive Burden (ACB) score. Dementia was adjudicated using Diagnostic and Statistical Manual of Mental Disorders volume IV criteria, and stroke using the World Health Organization definition. RESULTS At baseline, 15,000 participants (79%) had an ACB score of zero, 2930 (15%) a score of 1-2, and 1184 (6%) a score of ≥ 3 (indicating higher burden). After a median follow-up of 4.7 years and adjusting for baseline covariates, a baseline ACB score of ≥ 3 was associated with increased risk of ischemic stroke (adjusted HR 1.58, 95% CI 1.06, 2.35), or dementia (adjusted HR 1.36, 95% CI 1.01, 1.82), especially of mixed etiology (adjusted HR 1.53, 95% CI 1.06, 2.21). Results were similar for those exposed to moderate/highly anticholinergic medications. LIMITATIONS Residual confounding and reverse causality are possible. Assessment of dose or duration was not possible. CONCLUSIONS High anticholinergic burden in initially healthy older people was associated with increased risk of incident dementia and ischemic stroke. A vascular effect may underlie this association. These findings highlight the importance of minimizing anticholinergic exposure in healthy older people.
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Affiliation(s)
- Jessica E Lockery
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia.
| | - Jonathan C Broder
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Joanne Ryan
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Ashley C Stewart
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Robyn L Woods
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Trevor T-J Chong
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Geoffrey C Cloud
- Department of Clinical Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Anne Murray
- Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA
- Division of Geriatrics, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jason D Rigby
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Raj Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Elsdon Storey
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Stephanie A Ward
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
| | - Rory Wolfe
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Taya A Collyer
- Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Co-ordinating Centre, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
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Soysal T, Akın S, Durmuş NŞ, Gökçekuyu BM, Özer FF, Zararsız GE. Comparison of Anticholinergic Burden Measured with Three Different Anticholinergic Risk Scales and Association with Cognitive and Physical Functions in Older Adults. Arch Gerontol Geriatr 2021; 96:104451. [PMID: 34130072 DOI: 10.1016/j.archger.2021.104451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tuba Soysal
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Kayseri, 38090, Turkey.
| | - Sibel Akın
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Kayseri, 38090, Turkey
| | - Nurdan Şentürk Durmuş
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Kayseri, 38090, Turkey
| | - Bilge Müge Gökçekuyu
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Kayseri, 38090, Turkey
| | - Firuzan Fırat Özer
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Kayseri, 38090, Turkey
| | - Gözde Ertürk Zararsız
- Erciyes University Faculty of Medicine, Department of Biostatistics, Kayseri, 38090, Turkey
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Rodríguez-Ramallo H, Báez-Gutiérrez N, Prado-Mel E, Alfaro-Lara ER, Santos-Ramos B, Sánchez-Fidalgo S. Association between Anticholinergic Burden and Constipation: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9050581. [PMID: 34068348 PMCID: PMC8153334 DOI: 10.3390/healthcare9050581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
The association between anticholinergic burden and constipation is not well defined and documented; for this reason, a systematic review was carried out in five databases (Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus), including studies assessing the correlation between anticholinergic burden, and constipation between January 2006 and December 2020. Data extraction was conducted independently by two researchers. Abstracts and titles were reviewed to determine eligibility for review with eligible articles read in full. From 2507 identified articles, 11 were selected for this review: six cross-sectional studies, four retrospective cohort studies, and a post hoc analysis of a randomized clinical trial. Overall, nine studies reported at least one statistical association between anticholinergic burden and constipation, finding 13 positive results out of 24 association measurements. A total of 211,921 patients were studied. The association between constipation and anticholinergic burden could be demonstrated in studies including 207,795 patients. Most studies were not designed to find differences in constipation prevalence and did not adjust the results by confounding factors. Our findings suggest that a correlation between anticholinergic burden and constipation exists. Higher quality-evidence studies are needed, including analysis that considers confounding factors, such as other non-pharmacological causes of constipation.
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Affiliation(s)
- Héctor Rodríguez-Ramallo
- Pharmacy Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (H.R.-R.); (N.B.-G.); (E.P.-M.); (B.S.-R.)
| | - Nerea Báez-Gutiérrez
- Pharmacy Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (H.R.-R.); (N.B.-G.); (E.P.-M.); (B.S.-R.)
| | - Elena Prado-Mel
- Pharmacy Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (H.R.-R.); (N.B.-G.); (E.P.-M.); (B.S.-R.)
| | - Eva Rocío Alfaro-Lara
- Pharmacy Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (H.R.-R.); (N.B.-G.); (E.P.-M.); (B.S.-R.)
- Correspondence:
| | - Bernardo Santos-Ramos
- Pharmacy Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (H.R.-R.); (N.B.-G.); (E.P.-M.); (B.S.-R.)
| | - Susana Sánchez-Fidalgo
- Department of Preventive Medicine and Public Health, Universidad de Sevilla, 41009 Seville, Spain;
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Herrero-Zazo M, Berry R, Bines E, Bhattacharya D, Myint PK, Keevil VL. Anticholinergic burden in older adult inpatients: patterns from admission to discharge and associations with hospital outcomes. Ther Adv Drug Saf 2021; 12:20420986211012592. [PMID: 34035892 PMCID: PMC8111536 DOI: 10.1177/20420986211012592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Anticholinergic medications are associated with adverse outcomes in older adults and should be prescribed cautiously. We describe the Anticholinergic Risk Scale (ARS) scores of older inpatients and associations with outcomes. Methods: We included all emergency, first admissions of adults ⩾65 years old admitted to one hospital over 4 years. Demographics, discharge specialty, dementia/history of cognitive concern, illness acuity and medications were retrieved from electronic records. ARS scores were calculated as the sum of anticholinergic potential for each medication (0 = limited/none; 1 = moderate; 2 = strong and 3 = very strong). We categorised patients based on admission ARS score [ARS = 0 (reference); ARS = 1; ARS = 2; ARS ⩾ 3] and change in ARS score from admission to discharge [admission and discharge ARS = 0 (reference); same; decreased; increased]. We described anticholinergic prescribing patterns by discharge specialty and explored multivariable associations between ARS score categories and mortality using logistic regression [odds ratios (ORs), 95% confidence intervals (CIs)]. Results: From 33,360 patients, 10,183 (31%) were prescribed an anticholinergic medication on admission. Mean admission ARS scores were: Cardiology and Stroke = 0.56; General Medicine = 0.78; Geriatric Medicine = 0.83; Other medicine = 0.81; Trauma and Orthopaedics = 0.66; Other Surgery = 0.65. Mean ARS did not increase from admission to discharge in any specialty but reductions varied significantly, from 4.6% (Other Surgery) to 27.7% (Geriatric Medicine) (p < 0.001). The odds of both 30-day inpatient and 30-day post-discharge mortality increased with admission ARS = 1 (OR = 1.21, 95% CI 1.01–1.44 and OR = 1.44, 1.18–1.74) but not with ARS = 2 or ARS ⩾ 3. The odds of 30-day post-discharge mortality were higher in all ARS change categories, relative to no anticholinergic exposure (same: OR = 1.45, 1.21–1.74, decreased: OR = 1.27, 1.01–1.57, increased: OR = 2.48, 1.98–3.08). Conclusion: The inconsistent dose–response associations with mortality may be due to confounding and measurement error which may be addressed by a prospective trial. Definitive evidence for this prevalent modifiable risk factor is required to support clinician behaviour-change, thus reducing variation in anticholinergic deprescribing by inpatient speciality. Plain language summary We describe how commonly medicines which block the chemical acetylcholine are prescribed to older adults admitted to hospital as an emergency and explore links between these medicines and death during or soon after hospital admission Backgroud: Medicines which block the chemical acetylcholine are commonly prescribed to treat symptoms such as itch and difficulty sleeping or to treat medical conditions such as depression. However, some studies in older adults have found potential links between these medicines and confusion and falls. Therefore, doctors are recommended to prescribe these drugs cautiously in adults aged 65 years and over. Methods: In our paper we use data collected as part of routine medical care at one university hospital to describe how often these medicines are prescribed in a large sample of older adults admitted to hospital as an emergency. We look at the medicines patients are prescribed on admission to the hospital and also when they are later discharged. Results: We find that these medicines are frequently prescribed. We also find that, in general, patients are prescribed fewer of these potentially harmful medicines on hospital discharge compared with hospital admission. This suggests that clinicians are aware of advice to prescribe acetylcholine blocking medicines cautiously and they are more often stopped in hospital than started. However, we find a lot of variation in practice depending on which hospital specialty was caring for the patient during their inpatient stay. We also find potential links with these medicines and death during the admission or soon after hospital discharge, but these potential links are not always consistent. Conclusion: Further study is needed to fully understand links between medicines that block acetylcholine and late life health. This will be important to reduce variation in prescribing practices.
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Affiliation(s)
- Maria Herrero-Zazo
- European Molecular Biology Laboratory-European Bioinformatics Institute (EMBL-EBI), Hinxton, Cambridge, UK
| | - Rachel Berry
- Pharmacy Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma Bines
- Pharmacy Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Victoria L Keevil
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Box 157, Hills Road, Cambridge, CB2 0QQ, UK
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Lisibach A, Benelli V, Ceppi MG, Waldner-Knogler K, Csajka C, Lutters M. Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review. Eur J Clin Pharmacol 2021; 77:147-162. [PMID: 33011824 DOI: 10.1007/s00228-020-0299x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/10/2020] [Indexed: 05/23/2023]
Abstract
PURPOSE Older people are at risk of anticholinergic side effects due to changes affecting drug elimination and higher sensitivity to drug's side effects. Anticholinergic burden scales (ABS) were developed to quantify the anticholinergic drug burden (ADB). We aim to identify all published ABS, to compare them systematically and to evaluate their associations with clinical outcomes. METHODS We conducted a literature search in MEDLINE and EMBASE to identify all published ABS and a Web of Science citation (WoS) analysis to track validation studies implying clinical outcomes. Quality of the ABS was assessed using an adapted AGREE II tool. For the validation studies, we used the Newcastle-Ottawa Scale and the Cochrane tool Rob2.0. The validation studies were categorized into six evidence levels based on the propositions of the Oxford Center for Evidence-Based Medicine with respect to their quality. At least two researchers independently performed screening and quality assessments. RESULTS Out of 1297 records, we identified 19 ABS and 104 validations studies. Despite differences in quality, all ABS were recommended for use. The anticholinergic cognitive burden (ACB) scale and the German anticholinergic burden scale (GABS) achieved the highest percentage in quality. Most ABS are validated, yet validation studies for newer scales are lacking. Only two studies compared eight ABS simultaneously. The four most investigated clinical outcomes delirium, cognition, mortality and falls showed contradicting results. CONCLUSION There is need for good quality validation studies comparing multiple scales to define the best scale and to conduct a meta-analysis for the assessment of their clinical impact.
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Affiliation(s)
- Angela Lisibach
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland.
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, University of Geneva, Geneva, Switzerland.
| | - Valérie Benelli
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland
| | - Marco Giacomo Ceppi
- Department of Neurorehabilitation, RehaClinic, Bad Zurzach, Switzerland
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | | | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, University of Geneva, Geneva, Switzerland.
| | - Monika Lutters
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland
- Swiss Federal Institute of Technology, Zurich, Switzerland
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Fadare JO, Obimakinde AM, Aina FO, Araromi EJ, Adegbuyi TA, Osasona OE, Agbesanwa TA. Anti-Cholinergic Drug Burden Among Ambulatory Elderly Patients in a Nigerian Tertiary Healthcare Facility. Front Pharmacol 2021; 12:580152. [PMID: 33584317 PMCID: PMC7878669 DOI: 10.3389/fphar.2021.580152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/04/2021] [Indexed: 01/25/2023] Open
Abstract
Background: The use of drugs with anticholinergic effects among elderly patients is associated with adverse clinical outcomes. There is paucity of information about anticholinergic drug burden among Nigerian elderly population. Objectives: To determine the anticholinergic drug burden among elderly Nigerian patients. Methods: This was a retrospective cross-sectional study conducted among elderly patients (aged 65 and above) who visited the Family Medicine outpatients' clinics of the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria between July 1 and October 31, 2018. Information extracted from the case files included patient's age, sex, diagnoses, and list of prescribed medications. Medicines with anticholinergic effects were identified and scored using the anticholinergic drug burden calculator (http://www.acbcalc.com). Results: The medical records of 400 patients were analyzed with females accounting for 60.5% of the study population. The mean age of participants was 73 ± 7.4 years with only 28 (7%) of patients having more than two co-morbid conditions. Polypharmacy was identified in 152 (38%) of the patients while 147 (36.7%) had drugs with anticholinergic effects prescribed. The anticholinergic burden was high in 60 (15%) patients. Polypharmacy was significantly associated with having more than two diagnosed conditions and high anticholinergic burden (p value of < 0 .001 and 0.013 respectively). There was significant correlation between total number of prescribed drugs and count of diagnoses (r = 0.598; p < 0 .000) and between total number of prescribed drugs and number of drugs with anticholinergic effects (r = 0 .196; p < 0 .000). Conclusion: The anticholinergic burden in this group of elderly Nigerian patients was low; majority (67%) had no exposure to drugs with anticholinergic effects with only 15% having high anticholinergic burden. Polypharmacy and multiple diagnosed conditions were positively associated with high anticholinergic burden. Based on the positive and significant correlations found in this study, a reduction in the number of prescribed medicines especially those with significant anticholinergic effects used for secondary indications may lessen the anticholinergic burden among the elderly.
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Affiliation(s)
- Joseph O. Fadare
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Abimbola Margaret Obimakinde
- Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Family Medicine, University College Hospital Ibadan, Ibadan, Nigeria
| | - Felix O. Aina
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Ebisola J. Araromi
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
| | | | - Oluwatoba E. Osasona
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Tosin A. Agbesanwa
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
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13
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Martínez Arrechea S, Ferro Uriguen A, Beobide Telleria I, González Bueno J, Alaba Trueba J, Sevilla Sánchez D. [Prevalence of prescription of anticholinergic/sedative burden drugs among older people with dementia living in nursing homes]. Rev Esp Geriatr Gerontol 2020; 56:11-17. [PMID: 33309422 DOI: 10.1016/j.regg.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/03/2020] [Accepted: 09/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Dementia is one of the most frequent diseases in the elderly, being its prevalence of up to 64% in institutionalized people. In this population, in addition to antidementia drugs, it is common to prescribe drugs with anticholinergic/sedative burden that, due to their adverse effects, could worsen their functionality and cognitive status. The objective is to estimate the prevalence of the use of drugs with anticholinergic/ sedative burden in institutionalized older adults with dementia and to assess the associated factors. MATERIALS AND METHODS A cross-sectional study developed in older with dementia living in nursing homes. The prevalence of prescription of anticholinergic/sedative drugs was estimated according to the Drug Burden Index (DBI). A comparative analysis of the DBI score was performed between different types of dementia as well as among various factors and according to the anticholinergic/sedative risk, establishing as a cut-off point of DBI≥1 (high anticholinergic/sedative risk). RESULTS 178 residents were included. 83.7% had some drug with anticholinergic/sedative burden according to DBI. 50% had a DBI≥1 score. Residents with vascular dementia had a mean DBI of 1.34 (SD 0.84), a significantly higher score than residents with Alzheimer's disease (0.41, 95% CI 0.04-0.78).). Likewise, a higher DBI was associated with more polypharmacy (3.36; 95% CI 2.64-4.08), more falls, hospital admissions and emergency room visits (P<.05). CONCLUSIONS Polypharmacy and prescription of anticholinergic/sedative drugs is frequent among institutionalized older adults with dementia, finding an association between DBI, falls and hospital admissions or emergency department visits. Therefore, it is necessary to propose interdisciplinary pharmacotherapeutic optimization strategies.
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Affiliation(s)
- Silvia Martínez Arrechea
- Servicio de Farmacia, Hospital Ricardo Bermingham (Matia Fundazioa), San Sebastián, Guipúzcoa, España.
| | - Alexander Ferro Uriguen
- Servicio de Farmacia, Hospital Ricardo Bermingham (Matia Fundazioa), San Sebastián, Guipúzcoa, España
| | - Idoia Beobide Telleria
- Servicio de Farmacia, Hospital Ricardo Bermingham (Matia Fundazioa), San Sebastián, Guipúzcoa, España
| | - Javier González Bueno
- Servicio de Farmacia, Hospital Universitari de Vic (Consorci Hospitalari de Vic), Vic, Barcelona, España; Sistema Integral de Salut d'Osona (SISO), Vic, Barcelona, España; Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG)-Universitat de Vic/Universitat Central de Catalunya, Vic, Barcelona, España
| | - Javier Alaba Trueba
- Centro Residencial Fraisoro (Matia Fundazioa), San Sebastián, Guipúzcoa, España
| | - Daniel Sevilla Sánchez
- Servicio de Farmacia, Hospital Universitari de Vic (Consorci Hospitalari de Vic), Vic, Barcelona, España; Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG)-Universitat de Vic/Universitat Central de Catalunya, Vic, Barcelona, España; Servicio de Farmacia, Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, España
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Lisibach A, Benelli V, Ceppi MG, Waldner-Knogler K, Csajka C, Lutters M. Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review. Eur J Clin Pharmacol 2020; 77:147-162. [PMID: 33011824 PMCID: PMC7803697 DOI: 10.1007/s00228-020-02994-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022]
Abstract
Purpose Older people are at risk of anticholinergic side effects due to changes affecting drug elimination and higher sensitivity to drug’s side effects. Anticholinergic burden scales (ABS) were developed to quantify the anticholinergic drug burden (ADB). We aim to identify all published ABS, to compare them systematically and to evaluate their associations with clinical outcomes. Methods We conducted a literature search in MEDLINE and EMBASE to identify all published ABS and a Web of Science citation (WoS) analysis to track validation studies implying clinical outcomes. Quality of the ABS was assessed using an adapted AGREE II tool. For the validation studies, we used the Newcastle-Ottawa Scale and the Cochrane tool Rob2.0. The validation studies were categorized into six evidence levels based on the propositions of the Oxford Center for Evidence-Based Medicine with respect to their quality. At least two researchers independently performed screening and quality assessments. Results Out of 1297 records, we identified 19 ABS and 104 validations studies. Despite differences in quality, all ABS were recommended for use. The anticholinergic cognitive burden (ACB) scale and the German anticholinergic burden scale (GABS) achieved the highest percentage in quality. Most ABS are validated, yet validation studies for newer scales are lacking. Only two studies compared eight ABS simultaneously. The four most investigated clinical outcomes delirium, cognition, mortality and falls showed contradicting results. Conclusion There is need for good quality validation studies comparing multiple scales to define the best scale and to conduct a meta-analysis for the assessment of their clinical impact. Electronic supplementary material The online version of this article (10.1007/s00228-020-02994-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Angela Lisibach
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland. .,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland. .,School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, University of Geneva, Geneva, Switzerland.
| | - Valérie Benelli
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland
| | - Marco Giacomo Ceppi
- Department of Neurorehabilitation, RehaClinic, Bad Zurzach, Switzerland.,Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | | | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland. .,School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, University of Geneva, Geneva, Switzerland.
| | - Monika Lutters
- Clinical Pharmacy, Department Medical Services, Cantonal Hospital of Baden, Baden, Switzerland.,Swiss Federal Institute of Technology, Zurich, Switzerland
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15
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Amoros-Reboredo P, Soy D, Hernandez-Hernandez M, Lens S, Mestres C. Anticholinergic Burden and Safety Outcomes in Older Patients with Chronic Hepatitis C: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3776. [PMID: 32466526 PMCID: PMC7311997 DOI: 10.3390/ijerph17113776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 11/16/2022]
Abstract
AIM Older patients with chronic hepatitis C infection starting direct-acting antivirals (DAAs) are frequently prescribed multiple medications that may be categorized as inappropriate. Anticholinergic burden has been shown to be a predictor of adverse health and functional outcomes. Different scales are available to calculate anticholinergic burden. The aim of this study was to determine the prevalence of anticholinergic medication among older patients treated with DAAs and the risk factors associated using the Anticholinergic Cognitive Burden (ACB) scale, the Anticholinergic Risk Scale (ARS) and the Anticholinergic Drug Scale (ADS) and analyze the resulting safety consequences. METHODS Observational, retrospective cohort study of consecutive patients ≥65 years old receiving DAAs and taking concomitant medication. This study was conducted in accordance with the Strengthening the Reporting of observational studies in Epidemiology Statement. RESULTS 236 patients were included. The average age was 71.7 years, 73.3% cirrhotic, and 47% patients took ≥5 medicines. According to the ACB, ARS and ADS scales, 35.2% (n = 83), 10.6% (n = 25) and 34.3% (n = 81) of the patients were treated with anticholinergic medication. Two hundred-and-six (86%) patients presented any adverse events (AEs) during therapy. ARS scale showed a significant relationship between presence of anticholinergic medication and AEs. A large number of patients suffered anticholinergic events, with more events per patient in patients taking anticholinergic drugs. CONCLUSIONS Older hepatitis C chronic patients are exposed to potentially inappropriate polypharmacy and anticholinergic risk, according to the ACB, ARS and ADS scales. The three scales showed different results. Only the ARS scale was associated with AEs, but the rate of anticholinergic effects per patient was significantly higher in patients with anticholinergic drugs, regardless of the scale used. Consider quality of pharmacotherapy when starting DAA with a multidisciplinary approach could improve health outcomes.
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Affiliation(s)
| | - Dolors Soy
- Pharmacy Service Division of Medicines Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, 08036 Barcelona, Spain;
| | | | - Sabela Lens
- Liver Unit Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Conxita Mestres
- School of Health Sciences Blanquerna, University Ramon Llull, 08025 Barcelona, Spain;
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16
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Graves-Morris K, Stewart C, Soiza RL, Taylor-Rowan M, Quinn TJ, Loke YK, Myint PK. The Prognostic Value of Anticholinergic Burden Measures in Relation to Mortality in Older Individuals: A Systematic Review and Meta-Analysis. Front Pharmacol 2020; 11:570. [PMID: 32411001 PMCID: PMC7201087 DOI: 10.3389/fphar.2020.00570] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background Greater anticholinergic burden (ACB) increases the risk of mortality in older individuals, yet the strength of this association varies between studies. One possible explanation for this variance is the use of different approaches to quantify ACB. This systematic review (PROSPERO number CRD42019115918) assessed the prognostic utility of ACB-specific measures on mortality in older individuals. Methods Multiple cross-disciplinary databases were searched from 2006-2018. Observational studies assessing the association between ACB and mortality utilizing ≥1 ACB measure, involving persons aged ≥65 years were included. Screening and data extraction were performed by two independent reviewers, with disagreements resolved by a third independent reviewer. Risk of bias and quality of evidence were assessed using Quality in Prognosis Studies (QUIPS) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. Meta-analysis was conducted where appropriate. Results Of 19,224 titles, 20 articles describing 18 cohort studies involving 498,056 older individuals were eligible. Eight anticholinergic-specific measures were identified; the Anticholinergic Cognitive Burden Scale (ACBS, n=9) and Anticholinergic Risk scale (ARS, n=8) were most frequently reported. The evidence base was of poor quality, with moderate to high risk of bias. Meta-analysis showed increased mortality risk. Conclusions There was a modest association between some ACB measures and mortality, with most evidence derived from the ACBS. Studies comparing different measures within the same population were lacking. Analysis was limited by poor generalizability between studies, specifically regarding heterogeneity in methodology and reporting, as well as high risk of bias for most studies in the evidence base.
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Affiliation(s)
- Katherine Graves-Morris
- Ageing Clinical and Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Carrie Stewart
- Ageing Clinical and Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Roy L Soiza
- Ageing Clinical and Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom
| | - Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom
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17
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Jun K, Ah YM, Hwang S, Chung JE, Lee JY. Prevalence of anticholinergic burden and risk factors amongst the older population: analysis of insurance claims data of Korean patients. Int J Clin Pharm 2020; 42:453-461. [PMID: 32281075 DOI: 10.1007/s11096-020-01010-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/07/2020] [Indexed: 02/08/2023]
Abstract
Background Despite growing interest in the negative clinical outcomes of multiple anticholinergic use, limited studies have evaluated anticholinergic burden in the geriatric population nationally. Objective To evaluate the prevalence of high anticholinergic burden using the newly developed Korean Anticholinergic Burden Scale in comparison with previous tools and to identify associated factors. Setting National insurance data from a cross section (20%) of older Koreans (2016). Methods Anticholinergic burden was measured using the Korean scale in comparison to the Anticholinergic Drug Scale, Anticholinergic Cognitive Burden, and Anticholinergic Risk Scale. High anticholinergic burden was defined as a summed score of ≥ 3 for concurrent medications or a dose-standardized average daily score of ≥ 3, using each anticholinergic scale. Main outcomes measured Prevalence and predictors of high anticholinergic burden. Results Data of 1,292,323 patients were analyzed. According to the Korean scale, the prevalence of high anticholinergic burden was 25.5%. This result was similar to that from the Anticholinergic Drug Scale (24.9%) and Anticholinergic Cognitive Burden (22.2%). Factors associated with an increased likelihood of anticholinergic burden include: age, gender (female), high Charlson comorbidity index score, polypharmacy, medical aid beneficiary, co-morbidities (such as schizophrenia, depression, urinary incontinence, and Parkinson's disease), frequent healthcare visits, various healthcare facilities utilized, and predominantly visiting hospital-level facilities. According to the Korean Anticholinergic Burden Scale, the major drugs contributing to the anticholinergic burden were ranitidine, chlorpheniramine, tramadol, and dimenhydrinate. Conclusion This study showed that 1 in 4 older Koreans are exposed to high anticholinergic burden. The predictors identified in this research might assist pharmacists in early interventions for their patients.
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Affiliation(s)
- Kwanghee Jun
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan, Gyeongsangbuk-do, 38541, Republic of Korea
| | - Sunghee Hwang
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Gyeonggi-do, 15588, Republic of Korea
| | - Jee Eun Chung
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Gyeonggi-do, 15588, Republic of Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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18
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Rigor J, Rueff Rato I, Ferreira PM, Pereira R, Ribeiro C, Teixeira D, Mesquita Oliveira P, Silva AM, Pereira S, Costa I, Ferreira P, Sequeira M, Monteiro-Soares M, Martins-Mendes D. Prehospital Anticholinergic Burden Is Associated With Delirium but Not With Mortality in a Population of Acutely Ill Medical Patients. J Am Med Dir Assoc 2020; 21:481-485. [PMID: 31983551 DOI: 10.1016/j.jamda.2019.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Anticholinergic drugs have several side effects, and they have been associated with adverse outcomes, particularly in older patients. The aim of this study was to analyze anticholinergic burden and its relationship to delirium and mortality in older acutely ill medical patients. DESIGN Cohort study. SETTING AND PARTICIPANTS Patients 65 years of age and older who were admitted to an Internal Medicine ward between August 1 and December 31, 2016. METHODS Anticholinergic drug use, outpatient and inpatient, was assessed using the Anticholinergic Cognitive Burden Scale (ACB). Prevalent delirium was diagnosed by the Short Confusion Assessment Method (Short-CAM). RESULTS Of the 198 patients, 28.3% developed delirium. Mortality rate was 13.6% in-hospital and 45.6% at 12 months. In multivariate analysis, outpatient ACB was associated with delirium, with an odds ratio (OR) of 1.65 [95% confidence interval (CI) 1.09-2.51]. Those with delirium had longer hospital stays (median 13 vs 8 days; P = .01), received more drugs (median 18 vs 15; P = .02), and presented a higher inpatient ACB (mean 3.9 vs 3.1; P = .034). No increased risk was found for in-hospital or 12-month mortality with drug use, ACB, or delirium. DISCUSSION In the population studied, we found an association between anticholinergic burden as measured by the ACB and the presence of delirium, but not with mortality at 12 months. A very high 12-month mortality rate might have been an obstacle for association recognition. CONCLUSIONS AND IMPLICATIONS Clinician awareness of possible drug side effects, especially in older populations, is crucial. As part of medication reconciliation at the time of hospitalization, ACB of prehospitalization medications should be routinely calculated by inpatient pharmacy services and made available to medical teams.
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Affiliation(s)
- Joana Rigor
- Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal.
| | - Inês Rueff Rato
- Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal
| | - Paula Marques Ferreira
- Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal
| | - Rita Pereira
- Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal
| | - Catarina Ribeiro
- Nephrology Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal
| | - Diogo Teixeira
- Dermatology Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal
| | - Pedro Mesquita Oliveira
- Intensive Care Unit, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal
| | - Ana Mafalda Silva
- Internal Medicine Department, Entre Douro e Vouga Hospital Center, E.P.E., Santa Maria da Feira, Portugal
| | - Sofia Pereira
- Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal
| | - Ingride Costa
- Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal
| | - Paula Ferreira
- Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal
| | - Manuela Sequeira
- Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal
| | - Matilde Monteiro-Soares
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Daniela Martins-Mendes
- Internal Medicine Department, Vila Nova de Gaia/Espinho Hospital Center, E.P.E., Vila Nova de Gaia, Portugal; Biomedicine Department, Faculty of Medicine of the University of Porto, Porto, Portugal; i3S-Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
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Association between anticholinergic drug burden and mortality in older people: a systematic review. Eur J Clin Pharmacol 2019; 76:319-335. [PMID: 31832732 DOI: 10.1007/s00228-019-02795-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/05/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE The purpose of the study is to conduct a systematic review of studies examining the association between anticholinergic burden and mortality in older individuals. METHODS A literature search was performed to identify relevant studies, using MEDLINE, EMBASE, PsycINFO and CENTRAL, from January 1990 to December 2018. We included studies of patients with a mean age of 65 years or older where the anticholinergic burden was estimated using anticholinergic risk assessment tools, and associations between anticholinergic load and mortality were investigated. The primary outcome of interest was the association between anticholinergic burden and mortality. RESULTS Twenty-seven studies were included. These were three cross-sectional, one nested case-control and 23 prospective or retrospective cohort studies. Most studies were determined to be of good quality. A total of 15 studies reported a positive correlation between anticholinergic burden and mortality, while the remaining 10 studies did not report a significant association. Eighteen out of 27 studies (80%) had a short follow-up period of 1 year or less. Among the five high-quality studies that met all the domains of the quality assessment criteria, four showed a positive association. CONCLUSION The variation in results could relate to the quality of the studies, follow-up period, anticholinergic risk assessment tool used and the study setting. Sixty-three percent (n = 17) of all the included studies, but almost all of the high-quality studies with an extended follow-up, reported a positive correlation between anticholinergic burden and mortality. Further high-quality research, using standardized measures and with adequate follow-up periods, is required to confirm the relationship between anticholinergic burden and mortality.
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