Anticholinergic Exposure in a Cohort of Adults Aged 80 years and Over

Abstract

Anticholinergics are frequently prescribed for older adults and can lead to adverse drug events. The novel MARANTE (Muscarinic Acetylcholinergic Receptor ANTagonist Exposure) scale measures the anticholinergic exposure by incorporating potency and dosages of each medication into its calculations. The aims were to assess prevalence and intensity of the anticholinergic exposure in a longitudinal cohort study of community‐dwelling patients aged 80 years and over (n = 503) and to study the impact on mortality and hospitalization. Chronic medication use at baseline (November 2008–September 2009) was entered and codified with the Anatomical Therapeutic Chemical classification. Time‐to‐event analysis until first hospitalization or death was performed at 18 months after inclusion, using Kaplan–Meier curves. Cox regression was performed to control for covariates. Mean age was 84 years (range 80–102), and mean number of medications was 5 (range 0–16). Prevalence of anticholinergic use was 31.8%, with 9% taking ≥2 anticholinergics (range 0–4). Main indications for anticholinergics were depression, pain and gastric dysfunction. Female gender, the level of multi‐morbidity and the number of medications were associated with anticholinergic use. Mortality and hospitalization rate were 8.9% and 31.0%, respectively. After adjustment for the level of multi‐morbidity and medication intake, multi‐variable analysis showed increased risks of mortality (HR 2.3, 95% CI: 1.07–4.78) and hospitalization (HR 1.7; 95% CI: 1.13–2.59) in those with high anticholinergic exposure. The longitudinal study among Belgian community‐dwelling oldest old demonstrated great anticholinergic exposure, which was associated with increased risk of mortality and hospitalization after 18 months.

Effect of anticholinergic burden on the onset of delirium in elderly hospitalized patientsassessed by 3 anticholinergic scales

“…This discrepancy may result from the great heterogeneity of the studies included in the literature reviews, whether due to the characteristics of the study (delirium is rarely the primary objective of the study), the study population (number of patients included, settings, age) or the scale used, the most commonly used scales being ACB and ADS 16,24,26,28 . According the litterature, only one study has analyzed modi ed ADS 22 and two other have evaluated MARANTE scale 14,30 , which make it di cult to compare. In a recent study comparing 16 anticholinergic burden scales, Anticholinergic Cognitive load scale and ADS were considered to be the scales with the best inter-score agreement, with an inter-score correlation coe cient of 0.82.…”

Feasibility, acceptability and potential effectiveness of an information technology-based, pharmacist-led intervention to prevent an increase in anticholinergic and sedative load among older community-dwelling individuals

“…30 Furthermore, while we used the DBI to calculate the anticholinergic/sedative load, other tools have been developed, among those, one that shows promising results. 31,32 Finally while the feasibility, acceptability and potential effectiveness of the intervention appears high, the cost-effectiveness and implementation of medication recommendations and long-term medication changes in combination with relevant patient outcomes, like geriatric outcomes (e.g. fall risk, frailty and cognitive function) and adverse events (e.g.…”

The Prognostic Value of Anticholinergic Burden Measures in Relation to Mortality in Older Individuals: A Systematic Review and Meta-Analysis

“…Fox 2011 classed "low" exposure as ACBS one or more and "high" as ACBS two or more. Wauters et al (2017). These measures were: Clinician Rated Anticholinergic Scale (CrAS); Chew; Duran's list; MARANTE.…”

“…Agar et al (2010) stated "Log-rank data showed no evidence that survival differed significantly between the three groups," however, no quantitative data were provided. Significant associations between ACB and mortality were produced by Gutieŕrez-Valencia et al (2017) [Duran's=1, OR 1.69 (95%CI 1.02-2.82) and Wauters et al (2017) (MARANTE "high" ≥2: HR 2.20 (95%CI 1.03-4.67)].…”