Relation Between Delirium and Anticholinergic Drug Burden in a Cohort of Hospitalized Older Patients: An Observational Study

Pasina, Luca; Colzani, Lorenzo; Cortesi, Laura; Tettamanti, Mauro; Zambon, Antonella; Nobili, Alessandro; Mazzone, Andrea; Mazzola, Paolo; Annoni, Giorgio; Bellelli, Giuseppe

doi:10.1007/s40266-018-0612-9

Cited by 52 publications

(42 citation statements)

References 35 publications

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“…Cardiovascular diseases. Drugs with anticholinergic action such as warfarin or digoxin are essential for the prevention of cardiovascular and cerebrovascular events and do not always have adequate alternatives (Pasina et al, 2019). Therefore, their use should be prioritized over other drugs with anticholinergic action that may be necessary to prescribe.…”

Section: Discussion and Recommendations For Clinical Practicementioning

confidence: 99%

“…While it has been reported that during hospital admission the number of patients who receive anticholinergics and their related anticholinergic load increases, it is not yet clarified whether this is related to the medical circumstances of the hospitalization or the circumstances around the hospitalization itself (Brombo et al, 2018). However, this increase affects 79% of the hospitalized patients (Pasina et al, 2019). In addition, around the 20% of the patients in specialized geriatric hospitalization units -a setting where the use of anticholinergics is often well scrutinized -receive high-potency drugs (Pfistermeister et al, 2017), which supports the idea that in a significant number of cases, this use is not easily avoidable.…”

Section: Prevalencementioning

confidence: 99%

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Anticholinergic Drugs in Geriatric Psychopharmacology

López-Álvarez¹,

Sevilla‐Llewellyn‐Jones

Agüera-Ortíz³

2019

Front. Neurosci.

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Drugs with anticholinergic action are widely prescribed in the elderly population due to their potential clinical benefits. However, these benefits are limited by adverse effects which may be serious in particular circumstances. This review presents different aspects of the use of anticholinergics in old age with a focus in psychogeriatric patients. We critically review published data on benefits and disadvantages of anticholinergics, which are often controversial. Prevalence, pathophysiology and measurement methods of the anticholinergic action of drugs are discussed. We also present the most important drawbacks resulting from its use, including effects on cognition in healthy and cognitively impaired people, in aged schizophrenia patients, emergence of delirium and psychiatric symptoms, influence in functionality, hospitalization, institutionalization and mortality, and the potential benefits and limitations of their discontinuation. Finally, we suggest practical recommendations for the safe use of anticholinergics in clinical conditions affecting elderly patients, such as dementia, schizophrenia and acute hallucinatory episodes, depression, anxiety, Parkinson’s disease, cardiovascular conditions and urinary incontinence.

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Section: Discussion and Recommendations For Clinical Practicementioning

confidence: 99%

Section: Prevalencementioning

confidence: 99%

Anticholinergic Drugs in Geriatric Psychopharmacology

López-Álvarez¹,

Sevilla‐Llewellyn‐Jones

Agüera-Ortíz³

2019

Front. Neurosci.

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“…[25] A recent retrospective analysis found that if older hospitalized adults scored 3 or higher on the ACBS, they had a 3-6 fold increased risk of developing delirium compared to those who score < 3 on this tool. [26] In older adults with mild to moderate Alzheimer's disease who were APOE-ε4 carriers, there was a positive correlation between greater progression of dementia severity and continued use of anticholinergic medications. [27] In addition to the CNS effects of anticholinergic agents in older adults, another concern is the risk of falls and fracture.…”

Section: Skeletal Muscle Relaxantsmentioning

confidence: 95%

Assessing Anticholinergic Effects in Older Adults

Lisi¹

2021

Update in Geriatrics

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Anticholinergic medications are widely used in older adults and are a common source of adverse events in this population. Common drug classes include antiarrhythmics, antidepressants, antiemetics, first generation antihistamines, urinary incontinence antimuscarinic agents, antiparkinsonian agents, antipsychotics, antispasmodics, and skeletal muscle relaxants. These drugs have been associated with delirium, cognitive impairment, sedation, dizziness, falls, fracture, constipation, urinary retention, blurred vision, tachycardia and dry mouth. If possible, these drugs should be avoided in older adults or less toxic agents within the class should be utilized. This chapter will explore the mechanism of action of anticholinergic drugs at both the cellular and organ system level; discuss how to assess for anticholinergic drug burden; list medications with anticholinergic effects as identified in the Beer’s criteria on potentially inappropriate medication use in older adults; review anticholinergic drug–drug interactions; describe contraindications to the use of anticholinergic agents; and explore practical considerations such as the availability of these substances in nonprescription medications, their use at end of life and deprescribing.

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“…A previous study reported that patients who scored three or more on the ACB scale had about three to six times the risk of delirium than those not taking anticholinergic drugs [19]. In the same study, according to the ACB scale, 377 inpatients (79.0%) received at least one anticholinergic drug [19]. In our study, inpatients with severe ADEs had a significant increase in both ACB scale (mean 2.9) and DDIs (mean total score 7.9, class D 1.6, class C + D 3.6).…”

Section: Strengths and Weakness Of The Studymentioning

confidence: 99%

Using INTERCheck® to Evaluate the Incidence of Adverse Events and Drug–Drug Interactions in Out- and Inpatients Exposed to Polypharmacy

Martocchia

Spuntarelli

Aiello

et al. 2020

Drugs - Real World Outcomes

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Background Polypharmacy exposes patients with comorbidities (particularly elderly patients) to an increased risk of drug-specific adverse events and drug-drug interactions. These adverse events could be avoided with the use of a computerized prescription support system in the primary care setting. The INTERCheck ® software is a prescription support system developed with the aim of balancing the risks and benefits of polytherapy and examining drug-drug interactions. Objectives This observational study used the INTERCheck ® software to evaluate the incidence of adverse events and of drug-drug interactions in outpatients and inpatients receiving multiple medications. Methods Patients were randomly enrolled from the outpatient department (n = 98) and internal medicine ward (n = 46) of S. Andrea Hospital of Rome. Polypharmacological treatment was analyzed using INTERCheck ® software, and the prevalence of risk indicators and adverse events was compared between the two groups. Results Polypharmacy (use of five or more drugs) applied to all except three cases among outpatients and one case among inpatients. A significant positive correlation was found between the number of medications and the INTERCheck ® score (ρ = 0.67; p < 0.000001), and a significant negative correlation was found between the drugrelated anticholinergic burden and cognitive impairment (r = − 0.30 p = 0.01). Based on the INTERCheck ® analysis, inpatients had a higher score for class D (contraindicated drug combination should be avoided) than did outpatients (p = 0.01). The potential class D drug-drug interactions were associated with adverse events that caused hospitalization (χ 2 = 7.428, p = 0.01). Conclusions INTERCheck ® analysis indicated that inpatients had a high risk of drug-drug interactions and a high percentage of related adverse drug events. Further prospective studies are necessary to evaluate whether the INTERCheck ® software may help reduce polypharmacy-related adverse events when used in a primary care setting and thus potentially avoid related hospitalization and severe complications such as physical and cognitive decline.

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Relation Between Delirium and Anticholinergic Drug Burden in a Cohort of Hospitalized Older Patients: An Observational Study

Cited by 52 publications

References 35 publications

Anticholinergic Drugs in Geriatric Psychopharmacology

Anticholinergic Drugs in Geriatric Psychopharmacology

Assessing Anticholinergic Effects in Older Adults

Using INTERCheck® to Evaluate the Incidence of Adverse Events and Drug–Drug Interactions in Out- and Inpatients Exposed to Polypharmacy

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