Size of the associations between anticholinergic burden tool scores and adverse outcomes in older patients

Abstract

Background Several anticholinergic scales and equations to evaluate the anticholinergic burden have been previously created. Association of these instruments with the anticholinergic outcomes are usually estimated by means of hypothesis contrast tests, which ignore the size of the association effect. Objective To evaluate the effect size of the associations between the scores on cumulative anticholinergic burden instruments with peripheral or central anticholinergic adverse outcomes in older patients. Setting Internal medicine ward of a Tertiary University Hospital. Methods A case-control study was conducted in patients over 65 years who were admitted to two internal medicine wards of a Portuguese university hospital. The Anticholinergic Drug Scale, Anticholinergic Risk Scale, Anticholinergic Cognitive Burden scale and Drug Burden Index were used to calculate the patients' anticholinergic burden. Peripheral (dry mouth-swab technique; dry eye-Schirmer test) and central (falls and cognitive impairment-Mini-Mental State Examination) anticholinergic adverse outcomes were investigated. The Barthel Index was used to assess overall physical functionality. The Mann-Whitney test was used to evaluate probabilistic differences in the anticholinergic scores between case and control individuals. To establish the effect size of the associations, the area under the curve of the receiver operating characteristics curve was calculated. Main outcome measure Anticholinergic adverse effects. Results A total of 250 patients (mean age 81.67 years, standard deviation 7.768; 50% females) were included. In total, 148 patients (59.2%) presented with dry mouth, 85 (34%) with dry eye, 141 (56.4%) with impaired functionality, 44 (17.6%) with a history of falls and 219 (87.6%) with cognitive impairment. Significant differences (p < 0.05) were obtained for the majority of the associations between Anticholinergic Drug Scale, Anticholinergic Risk Scale, Anticholinergic Cognitive Burden and Drug Burden Index and adverse effects. Conversely, the effect sizes of these associations ranged from "fail" (area under the curve 0.5 to 0.6) to "fair" (area under the curve 0.7 to 0.8). Conclusion Although significant differences in the scores of anticholinergic burden instruments and adverse outcomes may exist, the effect sizes of these associations ranged from 'fail' to 'fair', which limits their utility in preventing anticholinergic adverse outcomes with medication review interventions. Keywords Aged • Cholinergic antagonists • Reproducibility of results • Risk assessment • ROC curve

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

“…The impact of the anticholinergic burden on nutrition may be explained by the gastrointestinal system and cognitive effects of anticholinergic agents (5). One of the well-known peripheral side effects, dry mouth (xerostomia), leads to poor dentition, altered taste, difficulty in deglutition, and digestion (34). Dysphagia makes the development of aspiration more likely and causes serious complications such as aspiration pneumonia.…”

The risk of delirium and falls or fractures with the use of overactive bladder anticholinergic medications

“…Much of the previous study on this topic has used measures of anticholinergic burden to determine the risk of delirium. Unfortunately, these scales have significant variability, 23 and in a systematic review, the association between delirium and anticholinergics varied based on the method used to calculate anticholinergic burden 10 . This likely contributes to some of the variability in the literature, and may account for clinical studies supporting a lack of association between anticholinergic medications and delirium 24 …”

Association between anticholinergic burden and anticholinergic adverse outcomes in the elderly: Pharmacological basis of their predictive value for adverse outcomes

“…The ADS presented a significant association with dry mouth in 2 studies [12,81] but not with constipation [12]. Lavrador et al [63] demonstrated that the ARS performed better than the ACB, ADS and DBI in predicting these peripheral negative outcomes, although the effect size was weak.…”

“…Initially, the minimum recommended daily dose was established according to approved US Food and Drug Administration (FDA) information. Further studies using the DBI established the British National Formulary as the gold standard for obtaining this information [63].…”

“…Statistical methods may also produce misleading conclusions. Lavrador et al demonstrated that the associations found using null hypothesis tests were negligible when their effect size measures were taken into consideration [63].…”