The excess mortality risk associated with anticholinergic burden among older patients discharged from acute care hospital with depressive symptoms

Andrea Corsonello, Annalisa Cozza, Sonia D'Alia, Graziano Onder, Stefano Volpato, Carmelinda Ruggiero, Antonio Cherubini, Mirko Di Rosa, Paolo Fabbietti, Fabrizia Lattanzio

Research output: Contribution to journalArticle

Abstract

Background: The relationship between anticholinergic burden and mortality is controversial, and the impact of anticholinergic burden on prognosis may vary in presence of other conditions common in old age. We aimed at investigating the role of depressive symptoms as potential effect modifiers in the association between anticholinergic burden and 1-year mortality in older patients discharged from hospital. Methods: Our series consisted of 576 older patients consecutively admitted to seven geriatric and internal medicine acute care wards in the context of a prospective multicenter observational study. Overall anticholinergic burden was assessed by Anticholinergic Cognitive Burden (ACB) score. Depressive symptoms were assessed by 15-item Geriatric Depression Scale (GDS). The study outcome was all-cause mortality during 12-months follow-up. Statistical analysis was carried out by Cox regression analysis. Results: After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with GDS > 5 (HR = 3.70; 95%CI = 1.18–11.6), but not among those with GDS ≤ 5 (HR = 2.32; 95%CI = 0.90–6.24). The association was confirmed among depressed patients after adjusting for ACB score at 3-month follow-up (HR = 3.58; 95%CI = 1.21–10.7), as well as when considering ACB score as a continuous variable (HR = 1.42; 95%CI = 1.10–1.91). The interaction between ACB score at discharge and BADL dependency was statistically significant (p <.005). Conclusions: ACB score at discharge may predict mortality among older patients discharged from acute care hospital carrying high GDS score e. Hospital physician should be aware that prescribing anticholinergic medications in such a vulnerable population may have negative prognostic implications.

Original languageEnglish
JournalEuropean Journal of Internal Medicine
DOIs
Publication statusE-pub ahead of print - Nov 15 2018

Fingerprint

Cholinergic Antagonists
Depression
Mortality
Geriatrics
Vulnerable Populations
Internal Medicine
Multicenter Studies
Observational Studies
Regression Analysis
Outcome Assessment (Health Care)
Physicians

Keywords

  • 15-item Geriatric Depression Scale (GDS)
  • Anticholinergic cognitive burden (ACB)
  • Hospital
  • Older
  • Survival

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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title = "The excess mortality risk associated with anticholinergic burden among older patients discharged from acute care hospital with depressive symptoms",
abstract = "Background: The relationship between anticholinergic burden and mortality is controversial, and the impact of anticholinergic burden on prognosis may vary in presence of other conditions common in old age. We aimed at investigating the role of depressive symptoms as potential effect modifiers in the association between anticholinergic burden and 1-year mortality in older patients discharged from hospital. Methods: Our series consisted of 576 older patients consecutively admitted to seven geriatric and internal medicine acute care wards in the context of a prospective multicenter observational study. Overall anticholinergic burden was assessed by Anticholinergic Cognitive Burden (ACB) score. Depressive symptoms were assessed by 15-item Geriatric Depression Scale (GDS). The study outcome was all-cause mortality during 12-months follow-up. Statistical analysis was carried out by Cox regression analysis. Results: After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with GDS > 5 (HR = 3.70; 95{\%}CI = 1.18–11.6), but not among those with GDS ≤ 5 (HR = 2.32; 95{\%}CI = 0.90–6.24). The association was confirmed among depressed patients after adjusting for ACB score at 3-month follow-up (HR = 3.58; 95{\%}CI = 1.21–10.7), as well as when considering ACB score as a continuous variable (HR = 1.42; 95{\%}CI = 1.10–1.91). The interaction between ACB score at discharge and BADL dependency was statistically significant (p <.005). Conclusions: ACB score at discharge may predict mortality among older patients discharged from acute care hospital carrying high GDS score e. Hospital physician should be aware that prescribing anticholinergic medications in such a vulnerable population may have negative prognostic implications.",
keywords = "15-item Geriatric Depression Scale (GDS), Anticholinergic cognitive burden (ACB), Hospital, Older, Survival",
author = "Andrea Corsonello and Annalisa Cozza and Sonia D'Alia and Graziano Onder and Stefano Volpato and Carmelinda Ruggiero and Antonio Cherubini and {Di Rosa}, Mirko and Paolo Fabbietti and Fabrizia Lattanzio",
year = "2018",
month = "11",
day = "15",
doi = "10.1016/j.ejim.2018.11.004",
language = "English",
journal = "European Journal of Internal Medicine",
issn = "0953-6205",
publisher = "Elsevier B.V.",

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TY - JOUR

T1 - The excess mortality risk associated with anticholinergic burden among older patients discharged from acute care hospital with depressive symptoms

AU - Corsonello, Andrea

AU - Cozza, Annalisa

AU - D'Alia, Sonia

AU - Onder, Graziano

AU - Volpato, Stefano

AU - Ruggiero, Carmelinda

AU - Cherubini, Antonio

AU - Di Rosa, Mirko

AU - Fabbietti, Paolo

AU - Lattanzio, Fabrizia

PY - 2018/11/15

Y1 - 2018/11/15

N2 - Background: The relationship between anticholinergic burden and mortality is controversial, and the impact of anticholinergic burden on prognosis may vary in presence of other conditions common in old age. We aimed at investigating the role of depressive symptoms as potential effect modifiers in the association between anticholinergic burden and 1-year mortality in older patients discharged from hospital. Methods: Our series consisted of 576 older patients consecutively admitted to seven geriatric and internal medicine acute care wards in the context of a prospective multicenter observational study. Overall anticholinergic burden was assessed by Anticholinergic Cognitive Burden (ACB) score. Depressive symptoms were assessed by 15-item Geriatric Depression Scale (GDS). The study outcome was all-cause mortality during 12-months follow-up. Statistical analysis was carried out by Cox regression analysis. Results: After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with GDS > 5 (HR = 3.70; 95%CI = 1.18–11.6), but not among those with GDS ≤ 5 (HR = 2.32; 95%CI = 0.90–6.24). The association was confirmed among depressed patients after adjusting for ACB score at 3-month follow-up (HR = 3.58; 95%CI = 1.21–10.7), as well as when considering ACB score as a continuous variable (HR = 1.42; 95%CI = 1.10–1.91). The interaction between ACB score at discharge and BADL dependency was statistically significant (p <.005). Conclusions: ACB score at discharge may predict mortality among older patients discharged from acute care hospital carrying high GDS score e. Hospital physician should be aware that prescribing anticholinergic medications in such a vulnerable population may have negative prognostic implications.

AB - Background: The relationship between anticholinergic burden and mortality is controversial, and the impact of anticholinergic burden on prognosis may vary in presence of other conditions common in old age. We aimed at investigating the role of depressive symptoms as potential effect modifiers in the association between anticholinergic burden and 1-year mortality in older patients discharged from hospital. Methods: Our series consisted of 576 older patients consecutively admitted to seven geriatric and internal medicine acute care wards in the context of a prospective multicenter observational study. Overall anticholinergic burden was assessed by Anticholinergic Cognitive Burden (ACB) score. Depressive symptoms were assessed by 15-item Geriatric Depression Scale (GDS). The study outcome was all-cause mortality during 12-months follow-up. Statistical analysis was carried out by Cox regression analysis. Results: After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with GDS > 5 (HR = 3.70; 95%CI = 1.18–11.6), but not among those with GDS ≤ 5 (HR = 2.32; 95%CI = 0.90–6.24). The association was confirmed among depressed patients after adjusting for ACB score at 3-month follow-up (HR = 3.58; 95%CI = 1.21–10.7), as well as when considering ACB score as a continuous variable (HR = 1.42; 95%CI = 1.10–1.91). The interaction between ACB score at discharge and BADL dependency was statistically significant (p <.005). Conclusions: ACB score at discharge may predict mortality among older patients discharged from acute care hospital carrying high GDS score e. Hospital physician should be aware that prescribing anticholinergic medications in such a vulnerable population may have negative prognostic implications.

KW - 15-item Geriatric Depression Scale (GDS)

KW - Anticholinergic cognitive burden (ACB)

KW - Hospital

KW - Older

KW - Survival

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