Anticholinergic Burden is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital

Fabrizia Lattanzio, Graziano Onder, Mattia Miriam La Fauci, Stefano Volpato, Antonio Cherubini, Paolo Fabbietti, Carmelinda Ruggiero, Sabrina Garasto, Annalisa Cozza, Lucia Crescibene, Assunta Tarsitano, Andrea Corsonello

Research output: Contribution to journalArticle

Abstract

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

DESIGN: Prospective observational study.

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

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

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

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

Original languageEnglish
Pages (from-to)942-947
Number of pages6
JournalJournal of the American Medical Directors Association
Volume19
Issue number11
DOIs
Publication statusPublished - Nov 2018

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Cholinergic Antagonists
Activities of Daily Living
Mortality
Geriatrics
Italy
Observational Studies
Outcome Assessment (Health Care)
Prospective Studies
Physicians

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Anticholinergic Burden is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital. / Lattanzio, Fabrizia; Onder, Graziano; La Fauci, Mattia Miriam; Volpato, Stefano; Cherubini, Antonio; Fabbietti, Paolo; Ruggiero, Carmelinda; Garasto, Sabrina; Cozza, Annalisa; Crescibene, Lucia; Tarsitano, Assunta; Corsonello, Andrea.

In: Journal of the American Medical Directors Association, Vol. 19, No. 11, 11.2018, p. 942-947.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVES: To determine whether anticholinergic burden may predict differently 1-year mortality in older patients discharged from acute care hospitals with or without dependency in basic activities of daily living (BADL).DESIGN: Prospective observational study.SETTING AND PARTICIPANTS: Our series consisted of 807 patients aged 65 years or older consecutively discharged from 7 acute care geriatric wards throughout Italy between June 2010 and May 2011.MEASURES: Overall anticholinergic burden was assessed by the anticholinergic cognitive burden (ACB) score. Dependency was rated by BADL, and dependency in at least 1 BADL was considered as a potential mediator in the analysis. The study outcome was all-cause mortality during 12-months of follow-up.RESULTS: Patients included in the study were aged 81.0 ± 7.4 years, and 438 (54.3{\%}) were female. During the follow-up period, 177 out of 807 participants (21.9{\%}) died. After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with dependency in at least 1 BADL [hazard ratio (HR) 2.25 95{\%} confidence (CI) 1.22‒4.14], but not among independent ones (HR 1.06 95{\%} CI 0.50‒2.34). The association was confirmed among dependent patients after adjusting for the number of lost BADL at discharge (HR 2.20 95{\%} CI 1.18‒4.04) or ACB score at 3-month follow-up (HR 2.18 95{\%} CI 1.20‒3.98), as well as when considering ACB score as a continuous variable (HR 1.28 95{\%} CI 1.11‒1.49). The interaction between ACB score at discharge and BADL dependency was highly significant (P < .001).CONCLUSIONS/IMPLICATIONS: ACB score at discharge may predict mortality among older patients discharged from an acute care hospital carrying at least 1 BADL dependency. Hospital physicians should be aware that prescribing anticholinergic medications in this population may have negative prognostic implications and they should try to reduce anticholinergic burden at discharge whenever possible.",
author = "Fabrizia Lattanzio and Graziano Onder and {La Fauci}, {Mattia Miriam} and Stefano Volpato and Antonio Cherubini and Paolo Fabbietti and Carmelinda Ruggiero and Sabrina Garasto and Annalisa Cozza and Lucia Crescibene and Assunta Tarsitano and Andrea Corsonello",
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TY - JOUR

T1 - Anticholinergic Burden is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital

AU - Lattanzio, Fabrizia

AU - Onder, Graziano

AU - La Fauci, Mattia Miriam

AU - Volpato, Stefano

AU - Cherubini, Antonio

AU - Fabbietti, Paolo

AU - Ruggiero, Carmelinda

AU - Garasto, Sabrina

AU - Cozza, Annalisa

AU - Crescibene, Lucia

AU - Tarsitano, Assunta

AU - Corsonello, Andrea

N1 - Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

PY - 2018/11

Y1 - 2018/11

N2 - OBJECTIVES: To determine whether anticholinergic burden may predict differently 1-year mortality in older patients discharged from acute care hospitals with or without dependency in basic activities of daily living (BADL).DESIGN: Prospective observational study.SETTING AND PARTICIPANTS: Our series consisted of 807 patients aged 65 years or older consecutively discharged from 7 acute care geriatric wards throughout Italy between June 2010 and May 2011.MEASURES: Overall anticholinergic burden was assessed by the anticholinergic cognitive burden (ACB) score. Dependency was rated by BADL, and dependency in at least 1 BADL was considered as a potential mediator in the analysis. The study outcome was all-cause mortality during 12-months of follow-up.RESULTS: Patients included in the study were aged 81.0 ± 7.4 years, and 438 (54.3%) were female. During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with dependency in at least 1 BADL [hazard ratio (HR) 2.25 95% confidence (CI) 1.22‒4.14], but not among independent ones (HR 1.06 95% CI 0.50‒2.34). The association was confirmed among dependent patients after adjusting for the number of lost BADL at discharge (HR 2.20 95% CI 1.18‒4.04) or ACB score at 3-month follow-up (HR 2.18 95% CI 1.20‒3.98), as well as when considering ACB score as a continuous variable (HR 1.28 95% CI 1.11‒1.49). The interaction between ACB score at discharge and BADL dependency was highly significant (P < .001).CONCLUSIONS/IMPLICATIONS: ACB score at discharge may predict mortality among older patients discharged from an acute care hospital carrying at least 1 BADL dependency. Hospital physicians should be aware that prescribing anticholinergic medications in this population may have negative prognostic implications and they should try to reduce anticholinergic burden at discharge whenever possible.

AB - OBJECTIVES: To determine whether anticholinergic burden may predict differently 1-year mortality in older patients discharged from acute care hospitals with or without dependency in basic activities of daily living (BADL).DESIGN: Prospective observational study.SETTING AND PARTICIPANTS: Our series consisted of 807 patients aged 65 years or older consecutively discharged from 7 acute care geriatric wards throughout Italy between June 2010 and May 2011.MEASURES: Overall anticholinergic burden was assessed by the anticholinergic cognitive burden (ACB) score. Dependency was rated by BADL, and dependency in at least 1 BADL was considered as a potential mediator in the analysis. The study outcome was all-cause mortality during 12-months of follow-up.RESULTS: Patients included in the study were aged 81.0 ± 7.4 years, and 438 (54.3%) were female. During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with dependency in at least 1 BADL [hazard ratio (HR) 2.25 95% confidence (CI) 1.22‒4.14], but not among independent ones (HR 1.06 95% CI 0.50‒2.34). The association was confirmed among dependent patients after adjusting for the number of lost BADL at discharge (HR 2.20 95% CI 1.18‒4.04) or ACB score at 3-month follow-up (HR 2.18 95% CI 1.20‒3.98), as well as when considering ACB score as a continuous variable (HR 1.28 95% CI 1.11‒1.49). The interaction between ACB score at discharge and BADL dependency was highly significant (P < .001).CONCLUSIONS/IMPLICATIONS: ACB score at discharge may predict mortality among older patients discharged from an acute care hospital carrying at least 1 BADL dependency. Hospital physicians should be aware that prescribing anticholinergic medications in this population may have negative prognostic implications and they should try to reduce anticholinergic burden at discharge whenever possible.

U2 - 10.1016/j.jamda.2018.06.012

DO - 10.1016/j.jamda.2018.06.012

M3 - Article

C2 - 30049542

VL - 19

SP - 942

EP - 947

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

IS - 11

ER -