Impact of anticholinergic burden on emergency department visits among older adults in Korea: A national population cohort study

Hwang, Sung‐Hee; Jun, Kwang‐Hee; Ah, Young Mi; Han, Euna; Chung, Jee Eun; Lee, Ju‐Yeun

doi:10.1016/j.archger.2019.103912

Cited by 19 publications

(33 citation statements)

References 28 publications

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“…In terms of medication, only detrusor relaxants were found to be associated with a PVR ≥ 300 ml. Higher overall scores on the anticholinergic burden scale and individual drugs with anticholinergic properties (such as antidepressants, antipsychotics and opioids), and loop diuretics were not associated with UR, which is unexpected [18,36]. This might be attributable to multiple factors.…”

Section: Discussionmentioning

confidence: 85%

Urinary retention on an acute geriatric hospitalisation unit: prevalence, risk factors and the role of screening, an observational cohort study

et al. 2021

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Purpose Urinary retention (UR) is common in older patients. The aim of this observational cohort study was to measure the prevalence of UR in patients aged ≥ 75 years on admission to an acute geriatric hospitalisation unit and to determine which at risk group would benefit from screening. Methods Post-void residual volumes (PVR) were measured within 3 days of admission with an ultrasound bladder scan. Uni- and multivariable analysis were used to determine risk factors associated with PVR ≥ 150 and ≥ 300 millilitres. Results Ninety-four patients, mean age 84.6 years, were included. The male/female ratio was 0.7. Patients with PVR ≥ 150 (29.8%) had more urological comorbidities, symptoms of overflow incontinence, voiding difficulties, subtotal voiding, faecal impaction, urinary tract infection (UTI) and were more frequently referred because of urinary symptoms. Patients with PVR ≥ 300 lived less at home, had more urological comorbidities, dysuria, voiding difficulties, subtotal voiding, constipation, faecal impaction, UTI, detrusor relaxants, and were more frequently referred because of urinary symptoms. Voiding difficulties and referral because of urinary symptoms were independently associated with PVR ≥ 150. Not living at home, reporting subtotal voiding, constipation, and referral because of urinary symptoms were independently associated with PVR ≥ 300. Conclusion Screening for UR on admission to an acute geriatric hospitalisation unit is most indicated in patients with urinary and defaecation problems. However, because the prevalence was high, because UR was also observed in patients without these problems, and history taking may be difficult, the threshold for PVR measurement in acutely ill geriatric patients should be low. Trial registration Clinicaltrials.gov NTC04715971, January 19, 2021 (retrospectively registered).

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Section: Discussionmentioning

confidence: 85%

Urinary retention on an acute geriatric hospitalisation unit: prevalence, risk factors and the role of screening, an observational cohort study

et al. 2021

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“…After the first review by title or abstract and removing duplicates, 57 articles were selected for a full-text review. Finally, 11 articles were included [ 10 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Most articles were excluded because constipation was not measured ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Included articles had remarkable differences between their aims: the majority of them aimed to estimate the possible relationship between the use of anticholinergic drugs and adverse outcomes [ 10 , 31 , 33 , 36 , 37 , 38 , 39 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

Association between Anticholinergic Burden and Constipation: A Systematic Review

et al. 2021

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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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“…The higher magnitude of anticholinergic activity leads to a higher score attributed to the drug [61]. Although there is no consensus in the literature, the average daily anticholinergic load ≥2 is considered high [62]. High anticholinergic burden is associated with increased risk of morbidity and mortality, hospital stay length, institutionalization, functional and cognitive decline [61].…”

Section: Auxiliary Instruments In the Active Search For Drps In The Context Of Drug-induced Deliriummentioning

confidence: 99%

“…It is noteworthy that drug toxicity and polypharmacy are two of the main risk factors associated to delirium, especially in older patients with underlying comorbidities [62]. Anticholinergic, antipsychotic, benzodiazepine, and opioid agents are known to be highly deliriogenic [50].…”

Section: Patient Safety Pharmacovigilance and Deliriummentioning

confidence: 99%

Drug-Induced Delirium among Older People

Varallo¹,

Oliveira²,

Zanetti³

et al. 2021

New Insights Into the Future of Pharmacoepidemiology and Drug Safety

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Although underdiagnosed, delirium is a common and potentially preventable problem in older patients, being associated with morbimortality. Drugs have been associated with the development of delirium in the geriatric population and may be considered the most easily reversible trigger. Polypharmacy, prescription of deliriogenic, anticholinergic and potentially inappropriate drugs are contributing factors for the occurrence of the disturb. Furthermore, changes in pharmacokinetic and pharmacodynamic parameters, which are intrinsic of the aged process, may contribute for cognitive impairment. Identification and reversal of clinical conditions associated with delirium are the first step to treat the disturbance, as well as mitigation of environmental factors and the exposition to deliriogenic drugs. Current evidence does not support the prescription of antipsychotics and benzodiazepines for the treatment of delirium. However, the judicious use of first- or second-generation antipsychotics can be considered in severe cases. Multi-component non-pharmacological, software-based intervention to identify medications that could contribute to delirium, predictive models, tools, training of health professionals and active actions of pharmacovigilance may contribute to the screening, prevention, and management of delirium in older people. Besides, it is also important to improve the report of drug-induced delirium in medical records, to develop properly risk management plans and avoid cascade iatrogenesis.

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Impact of anticholinergic burden on emergency department visits among older adults in Korea: A national population cohort study

Cited by 19 publications

References 28 publications

Urinary retention on an acute geriatric hospitalisation unit: prevalence, risk factors and the role of screening, an observational cohort study

Urinary retention on an acute geriatric hospitalisation unit: prevalence, risk factors and the role of screening, an observational cohort study

Association between Anticholinergic Burden and Constipation: A Systematic Review

Drug-Induced Delirium among Older People

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