Prehospital Anticholinergic Burden Is Associated With Delirium but Not With Mortality in a Population of Acutely Ill Medical Patients

• Type: Article in International Scientific Journal
• Date: 2020

Authors

Rigor, J (Author) Other; Rato, IR (Author) Other; Ferreira, PM (Author) Other; Pereira, R (Author) Other; Ribeiro, C (Author) Other; Teixeira, D (Author) Other; Oliveira, PM (Author) Other; Silva, AM (Author) Other; Pereira, S (Author) Other; Costa, I (Author) Other; Ferreira, P (Author) Other; Sequeira, M (Author) Other; Matilde Soares (Author) FMUP; Martins Mendes, D (Author) Other

Journal

Title: Journal of the American Medical Directors Association

Vol. 21

Pages: 481-485

ISSN: 1525-8610

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 8 Citations

Scopus - 8 Citations

Other information

Authenticus ID: P-00R-NFA

DOI: 10.1016/j.jamda.2019.12.018

Abstract (EN): Objectives: Anticholinergic drugs have several side effects, and they have been associated with adverse outcomes, particularly in older patients. The aim of this study was to analyze anticholinergic burden and its relationship to delirium and mortality in older acutely ill medical patients. Design: Cohort study. Setting and Participants: Patients 65 years of age and older who were admitted to an Internal Medicine ward between August 1 and December 31, 2016. Methods: Anticholinergic drug use, outpatient and inpatient, was assessed using the Anticholinergic Cognitive Burden Scale (ACB). Prevalent delirium was diagnosed by the Short Confusion Assessment Method (Short-CAM). Results: Of the 198 patients, 28.3% developed delirium. Mortality rate was 13.6% in-hospital and 45.6% at 12 months. In multivariate analysis, outpatient ACB was associated with delirium, with an odds ratio (OR) of 1.65 [95% confidence interval (CI) 1.09-2.51]. Those with delirium had longer hospital stays (median 13 vs 8 days; P = .01), received more drugs (median 18 vs 15; P = .02), and presented a higher inpatient ACB (mean 3.9 vs 3.1; P = .034). No increased risk was found for in-hospital or 12-month mortality with drug use, ACB, or delirium. Discussion: In the population studied, we found an association between anticholinergic burden as measured by the ACB and the presence of delirium, but not with mortality at 12 months. A very high 12-month mortality rate might have been an obstacle for association recognition. Conclusions and Implications: Clinician awareness of possible drug side effects, especially in older populations, is crucial. As part of medication reconciliation at the time of hospitalization, ACB of prehospitalization medications should be routinely calculated by inpatient pharmacy services and made available to medical teams. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 5