An Increased Anticholinergic Drug Burden Index Score Negatively Affect Nutritional Status in Older Patients Without Dementia

Abstract

Introduction/AimAnticholinergic drugs, which have severe central and peripheric side effects, are frequently prescribed to older adults. Increased anticholinergic drug burden is associated with poor physical and cognitive functions. On the other side, the impact of anticholinergics on nutritional status is not elaborated in the literature. Therefore, this study was aimed to investigate the effect of the anticholinergic burden on nutrition.Materials and MethodsPatients who underwent comprehensive geriatric assessment (CGA) 6 months apart were included in the study. Patients diagnosed with dementia were excluded because of the difference in the course of cognition, physical performance and nutrition. Nutritional status and global cognition were evaluated using Mini Nutritional Assessment-short form (MNA-SF), Mini-Mental State Examination (MMSE). Anticholinergic drug burden was assessed with the Drug Burden Index (DBI), enabling a precise dose-related cumulative exposure. Patients were divided into three groups according to DBI score: 0, no DBI exposure; 0–1, low risk; and ≥1, high risk. Regression analysis was performed to show the relationship between the difference in CGA parameters and the change in DBI score at the sixth month.ResultsA total of 423 patients were included in the study. Participants' mean age was 79.40 ± 7.50, and 68.6% were female. The DBI 0 score group has better MMSE and MNA-SF scores and a lower rate of falls, polypharmacy, malnutrition, and risk of malnutrition in the baseline. Having malnutrition or risk of malnutrition is 2.21 times higher for every one-unit increase in DBI score. Additionally, during the 6-month follow-up, increased DBI score was associated with decreased MNA-SF and MMSE score, albumin.ConclusionsThe harmful effects of anticholinergics may be prevented because anticholinergic activity is a potentially reversible factor. Therefore, reducing exposure to drugs with anticholinergic activity has particular importance in geriatric practice.

Medication‐related problems in geriatric psychiatry—a retrospective cohort study

“…The authors concluded that medication reviews are of paramount importance in the management of older patients 34 . Ates Bulut and co‐workers showed that an increased anticholinergic drug burden was associated with impaired cognitive functions and a decreased nutritional status in elderly patients 35 . Even though anticholinergic effects were evaluated as a subcategory of PDIs (Table 2), we did not specifically assess patients' anticholinergic drug burdens, which must be considered a further limitation of the present study.…”

“…Even though anticholinergic effects were evaluated as a subcategory of PDIs (Table 2), we did not specifically assess patients' anticholinergic drug burdens, which must be considered a further limitation of the present study. Interventions to minimize MRPs, such as interdisciplinary psychiatric ward rounds with medication reviews 36 (with a particular focus on drugs with anticholinergic properties 35 ), should be tested in prospective randomized clinical trials in the future.…”

Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review

“…Full‐text articles were sought and screened for 316 articles that appeared to meet the inclusion criteria. Seventy studies 6,13–81 were included in the systematic review (Figure 1).…”

Effect of drugs on nutritional status and drug–nutrition interactions in older patients

“…75,76 Although the effects of anticholinergic drugs on nutritional status have not yet been fully investigated, a cross-sectional study reported that the presence of anticholinergic burden is associated with the presence and increased risk of low nutrition in older patients. 77,78 In an observational study of 1490 older patients aged 65 years or older admitted to a convalescence rehabilitation ward in Japan, a comparison of nutritional status at discharge between those whose anticholinergic burden increased during hospitalization and those whose burden did not increase showed that the group with an increased anticholinergic burden had significantly worse nutritional status. 79 Although the mechanism has not been fully explored in this study, anticholinergic use may be associated with decreased food intake owing to decreased appetite.…”

“…Some systematic reviews have reported that anticholinergic drugs increase the risk for cognitive decline, delirium, falls, the development of physical decline and frailty, and even hospitalization and death 75,76 . Although the effects of anticholinergic drugs on nutritional status have not yet been fully investigated, a cross‐sectional study reported that the presence of anticholinergic burden is associated with the presence and increased risk of low nutrition in older patients 77,78 . In an observational study of 1490 older patients aged 65 years or older admitted to a convalescence rehabilitation ward in Japan, a comparison of nutritional status at discharge between those whose anticholinergic burden increased during hospitalization and those whose burden did not increase showed that the group with an increased anticholinergic burden had significantly worse nutritional status 79 .…”