Total anticholinergic burden and survival within a cohort of elderly Mexican Americans

Sarbacker, G. Blair; Espino, David V.; Wood, Robert C.; Oakes, S. Liliana; Anand, Dheeraj; Markides, Kyriakos

doi:10.1111/ggi.12907

Cited by 10 publications

(9 citation statements)

References 14 publications

(58 reference statements)

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“…Tools that did not provide gradable scores or without grading scores, and unavailable or outdated tools published before 1980 were excluded. The final list of tools included the Anticholinergic Cognitive Burden Scale and its modified lists, Anticholinergic Drug Scale and its modified list, Anticholinergic Risk Scale, Anticholinergic Loading Scale, Clinician‐rated Anticholinergic Score, Chew's list, Rating of Anticholinergic Activity Scale, and Anticholinergic Burden Classification . In addition to these lists, we included the anticholinergic medication lists from Beers Criteria 2015 1 and the strong anticholinergic medication lists suggested by Gray et al …”

Section: Methodsmentioning

confidence: 99%

Development of an Anticholinergic Burden Scale specific for Korean older adults

Jun

Hwang

et al. 2019

Geriatrics Gerontology Int

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Aim The aim of this study was to develop the Korean Anticholinergic Burden Scale through assessment of previously developed tools, a literature review and a modified Delphi process. Methods We carried out a systematic review to identify previously published anticholinergic burden tools. A composite medication list was made by extracting medications and their quantitative grading from the existing tools, after excluding the medications not distributed in Korea and topical agents. We also added medications available in Korea that had not been rated. For medications with conflicting anticholinergic scores or no anticholinergic score, we determined the final score from 0 (“no anticholinergic effect”) to 3 (“strong anticholinergic effect”) with a literature review and expert consensus through a two‐round Delphi process. Results A composite list of 655 medications with anticholinergic scores was extracted from 10 existing tools. A total of 38 medications available in Korea were added to the list. A total of 494 medications were deemed suitable for a Korean‐specific scale. We confirmed the anticholinergic scores of 352 medications from existing scales, and 142 underwent the Delphi process. The final scores graded by experts showed high reliability among experts with an intra‐class correlation of 0.98 (95% confidence interval 0.97–0.98). Finally, 56 medications were categorized as strong anticholinergics, 23 as moderate, 59 as weak and 356 as having no anticholinergic activity. Conclusions This newly created consensus‐driven anticholinergic burden scale designed specifically for the Korean healthcare system might be a practical tool for assessing anticholinergic burden in older adults with polypharmacy in routine medication reviews and in research. Geriatr Gerontol Int 2019; 19: 628–634.

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Section: Methodsmentioning

confidence: 99%

Development of an Anticholinergic Burden Scale specific for Korean older adults

Jun

Hwang

et al. 2019

Geriatrics Gerontology Int

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“…From the 147 evaluations, 15 reported on delirium [35,55,62,65,74,80,96,112,126,144,149], 54 on cognition [33, 34, 39, 57-61, 64-66, 71, 73, 76, 79, 82, 83, 97-99, 106, 107, 109, 114, 121, 127, 128, 140, 145, 146, 148], 20 on mortality [55,68,72,75,80,84,85,89,100,108,113,115,117,119,120,123,132,134,137,141] and 24 on falls [53,87,93,112,118,121,129,131,136,147] (Fig. 4).…”

Section: Impact Of Abs On Clinical Outcomesmentioning

confidence: 99%

Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review

Lisibach

Benelli

Ceppi

et al. 2020

Eur J Clin Pharmacol

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Purpose Older people are at risk of anticholinergic side effects due to changes affecting drug elimination and higher sensitivity to drug’s side effects. Anticholinergic burden scales (ABS) were developed to quantify the anticholinergic drug burden (ADB). We aim to identify all published ABS, to compare them systematically and to evaluate their associations with clinical outcomes. Methods We conducted a literature search in MEDLINE and EMBASE to identify all published ABS and a Web of Science citation (WoS) analysis to track validation studies implying clinical outcomes. Quality of the ABS was assessed using an adapted AGREE II tool. For the validation studies, we used the Newcastle-Ottawa Scale and the Cochrane tool Rob2.0. The validation studies were categorized into six evidence levels based on the propositions of the Oxford Center for Evidence-Based Medicine with respect to their quality. At least two researchers independently performed screening and quality assessments. Results Out of 1297 records, we identified 19 ABS and 104 validations studies. Despite differences in quality, all ABS were recommended for use. The anticholinergic cognitive burden (ACB) scale and the German anticholinergic burden scale (GABS) achieved the highest percentage in quality. Most ABS are validated, yet validation studies for newer scales are lacking. Only two studies compared eight ABS simultaneously. The four most investigated clinical outcomes delirium, cognition, mortality and falls showed contradicting results. Conclusion There is need for good quality validation studies comparing multiple scales to define the best scale and to conduct a meta-analysis for the assessment of their clinical impact.

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“…Out of them, five investigated postdischarge mortality, 39,44,46,50,51 six reports focused on a special population with dementia, 37,48,56 stroke, 42 depression, 38 and palliative care patients 55 and another six studies used data of outpatients or nursing homes. 40,41,43,47,49,54 Another two studies 45,53 are similar in terms of using data from patients older than 65 years. However, Mangoni et al, 45 finding no association with the ARS, additionally studied the impact of heat waves while Lu et al 53 uses a national health insurance database (no association with ARS), which is not clearly distinguishing between inpatients and outpatients.…”

Section: Primary Outcome Mortalitymentioning

confidence: 99%

High anticholinergic burden at admission associated with in‐hospital mortality in older patients: A comparison of 19 different anticholinergic burden scales

Lisibach

Gallucci

Beeler

et al. 2021

Basic Clin Pharma Tox

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Although no gold standard exists to assess a patient's anticholinergic burden, a review identified 19 anticholinergic burden scales (ABSs). No study has yet evaluated whether a high anticholinergic burden measured with all 19 ABSs is associated with in‐hospital mortality and length of stay (LOS). We conducted a cohort study at a Swiss tertiary teaching hospital using patients' electronic health record data from 2015–2018. Included were patients aged ≥65 years, hospitalised ≥48 h without stays and >24 h in intensive care. Patients' cumulative anticholinergic burden score was classified using a binary (<3: low, ≥3: high) and categorical approach (0: no, 0.5–3: low, ≥3: high). In‐hospital mortality and LOS were analysed using multivariable logistic and linear regression, respectively. We included 27,092 patients (mean age 78.0 ± 7.5 years, median LOS 6 days). Of them, 913 died. Depending on the evaluated ABS, 1370 to 17,035 patients were exposed to anticholinergics. Patients with a high burden measured by all 19 ABSs were associated with a 1.32‐ to 3.03‐fold increase in in‐hospital mortality compared with those with no/low burden. We obtained similar results for LOS. To conclude, discontinuing drugs with anticholinergic properties (score ≥3) at admission might be a targeted intervention to decrease in‐hospital mortality and LOS.

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Total anticholinergic burden and survival within a cohort of elderly Mexican Americans

Cited by 10 publications

References 14 publications

Development of an Anticholinergic Burden Scale specific for Korean older adults

Development of an Anticholinergic Burden Scale specific for Korean older adults

Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review

High anticholinergic burden at admission associated with in‐hospital mortality in older patients: A comparison of 19 different anticholinergic burden scales

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