The excess mortality risk associated with anticholinergic burden among older patients discharged from acute care hospital with depressive symptoms

Corsonello, Andrea; Cozza, Annalisa; D’Alia, Sonia; Onder, Graziano; Volpato, Stefano; Ruggiero, Carmelinda; Cherubini, Antonio; Rosa, Mirko Di; Fabbietti, Paolo; Lattanzio, Fabrizia

doi:10.1016/j.ejim.2018.11.004

Cited by 15 publications

(23 citation statements)

References 41 publications

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“…Another regional study (in south‐west France) showed that 32% of prescriptions dispensed by community pharmacists included at least one anticholinergic drug and 14% of the patients are more than 65 years of age [24]. However, the prevalence of anticholinergic drug use in persons over 65 years of age has decreased significantly, from 46% in 2006 to 33% in 2015, with octogenarians remaining the most exposed [9].…”

Section: Discussionmentioning

confidence: 99%

“…[8]. Consumption of these drugs is associated with a deterioration in quality of life and an increase in morbidity and mortality [8,9]. Three methods have been developed for assessing the anticholinergic potential of a drug: the anticholinergic activity in serum (AAS), in vitro measurement of the affinity of a drug for the muscarinic receptor and the compilation of a list of anticholinergic drugs by expert consensus [10].…”

Section: Introductionmentioning

confidence: 99%

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Are potentially inappropriate and anticholinergic medications being prescribed for institutionalized elderly subjects?

Bourrel

Zacarin

Rousseau

et al. 2020

Fundamemntal Clinical Pharma

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The PAAPI project (Optimising Inappropriate Prescriptions in the Elderly) is a multi‐disciplinary approach put in place by the Toulouse Pharmacovigilance Centre (CRPV) in order to improve drug prescribing practice in nursing homes. The aim of this study was to analyse the association between polypharmacy, frequency of prescriptions for potentially inappropriate medications (PIMs) and the anticholinergic burden of prescriptions in elderly patients from the PAAPI cohort. We carried out a retrospective study on residents of 24 nursing homes (EHPAD) participating in the PAAPI programme between 1er January 2017 and 31 December. Resident’s Data were collected in a single review in a random day. Drug prescriptions were analysed quantitatively and qualitatively. PIMs and anticholinergic drugs were identified by the list EU(7)PIM and the Duran scale, respectively. The total anticholinergic burden was calculated by adding the anticholinergic scores of each drug. We classified the drugs into three categories: no anticholinergic burden (burden = 0), low anticholinergic burden (≥1 ≤ 3) or high anticholinergic burden (burden > 3). A total of 1191 residents living were included, and we analysed 8869 drug prescription lines. The average age of the residents was 87.0 ± 8.3 years, and the majority (71.5%) were female. Nearly half of the residents (49.6%, n = 67) having a prescription with a high anticholinergic burden were taking more than 9 drugs (Fisher exact test P < 0.05). All the prescriptions with more than 5 PIMs (n = 23) had an anticholinergic burden > 0, with the majority (65.2%, n = 15) having a high anticholinergic burden (Kruskal–Wallis test, P < 0.0001). In this cohort, 88% (n = 539) of prescriptions with a low anticholinergic burden and 100% (n = 135) of prescriptions with a high anticholinergic burden included at least one PIM. According to our study, the anticholinergic burden of prescriptions given to residents in the PAAPI cohort is associated with the prescription of PIMs and with polypharmacy. Optimizing the use of medicines remains essential in this population, given the harmful properties of these drugs. It would also be useful for the list of anticholinergic drugs to be updated as new medicines come onto the market.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Are potentially inappropriate and anticholinergic medications being prescribed for institutionalized elderly subjects?

Bourrel

Zacarin

Rousseau

et al. 2020

Fundamemntal Clinical Pharma

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“…So, whenever urinary UI is detected in the old aged group if walking speed is also decreased, geriatric evaluation may result in detection of related geriatric syndromes which will increase in survival of patients, increase in quality of life, reduce polypharmacy, decrease falls and fall-related fractures, and decrease delirium incidence. In addition, anticholinergic drugs used for the treatment of UI, frequently results in decline in functional status, increase in delirium and dementia, increase in falls and depression and most important of all increase in mortality by its mechanism of action, so before starting drug treatment, geriatrician referral might help in excluding or detection of geriatric syndromes which is essential especially UI is a symptom or complication of an underlying geriatric syndrome (36)(37)(38). Lastly, most recently, an article was published in JAMA, with 3.5 million individuals of up to 20 years of follow up.…”

Section: Discussionmentioning

confidence: 99%

Association Between Walking Speed and Urinary Incontinence in the Older Women. Which Patients Should be Referred to Geriatricians?

Atmış

Guler

2020

Gynecol Obstet Reprod Med

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OBJECTIVE: Primary end-point of this study was to detect if there is an association between walking speed and urinary incontinence in older women and secondarily to detect an association between urinary incontinence with other geriatric syndromes.STUDY DESIGN: This is a prospective and cross-sectional study. Three hundred and eighty-nine old aged women admitted to the Geriatrics Department of Ankara University were enrolled and urinary incontinence and type of urinary incontinence, Handgrip strength test, Timed up and Go test, Katz Index of Independence in Activities of Daily Living, Lawton Index of Instrumental Activities of Daily Living, Mini Nutritional Assessment, Mini-Mental State Evaluation, Geriatric Depression Scale, Body Mass Index (BMI) of these participants were recorded. Association of urinary incontinence and these parameters were analyzed. RESULTS: The median age of the study population was 68 (58-86 years of age). Two hundred and fifty-eight (66.32%) had hypertension, 122 (31.36%) had diabetes mellitus, 51 (13.11%) had asthma/Chronic obstructive lung disease, 49 (12.59%) had coronary artery disease and 9 (2.31%) had cerebrovascular disease. One hundred and seventy-eight (45.7%) patients had urinary incontinence (88 urge, 55 stress, 35 mixed). One hundred and eight (27.76%) of patients had Mini-Mental State Evaluation score ≤23. Patients with urinary incontinence detected to have a longer duration of Timed Up and Go test, higher Geriatric Depression Scale score and BMI with p-values 0.005, 0.004, and <0.01 respectively; and lower Activities of Daily Living (Katz-Activities of Daily Living) score with a p-value of <0.01 results. Mini-Mental State Evaluation and Mini Nutritional Assessment scores were not statistically different between the continent and incontinent group.CONCLUSION: Whenever urinary incontinence is detected in an older woman, geriatrician referral should be considered since urinary incontinence is associated with decreased walking speed, Handgrip strength test, Activities of Daily Living, Instrumental Activities of Daily Living or increased Geriatric Depression Scale; any of which is a symptom or result of at least one geriatric syndrome.

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“…Other tools focus on the specific burden of ADRs, for example the cumulative exposure to drugs with anticholinergic properties (the anticholinergic burden). This has been linked to increased risk of dementia, 26 falls 27 and death 28 . The Drug Burden Index is a commonly used pharmacological measure of an individual's exposure to anticholinergic drugs, 29 and online calculators are available to assist in its use.…”

Section: Formal Methods For Detecting or Avoiding Problematic Polyphamentioning

confidence: 99%

Overprescribing and rational therapeutics: Barriers to change and opportunities to improve

Bennett

Ferner

Sofat

2020

Brit J Clinical Pharma

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There is increasing national and international interest in overprescribing and polypharmacy, and the burden that the inappropriate use of multiple medicines can place on individual patients and on society as a whole. This paper explores the challenges faced by prescribers and pharmacists wishing to reduce polypharmacy, including the uncertainties about the risks and benefits of continuing or stopping individual drugs. We discuss the factors influencing us to prescribe—which may lead to overprescribing—including the increasing number of guidelines, perceived patient pressure and advertising. We offer a critical appraisal of the tools currently available to clinicians and pharmacists aiming to rationalise medicines, and finally a systems‐wide approach to improving overprescribing and problematic polypharmacy.

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The excess mortality risk associated with anticholinergic burden among older patients discharged from acute care hospital with depressive symptoms

Cited by 15 publications

References 41 publications

Are potentially inappropriate and anticholinergic medications being prescribed for institutionalized elderly subjects?

Are potentially inappropriate and anticholinergic medications being prescribed for institutionalized elderly subjects?

Association Between Walking Speed and Urinary Incontinence in the Older Women. Which Patients Should be Referred to Geriatricians?

Overprescribing and rational therapeutics: Barriers to change and opportunities to improve

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