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Anticholinergic burden and health outcomes among older adults discharged from hospital: results from the CRIME study

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

The purpose of this study is to investigate whether there is an association between anticholinergic burden and mortality or rehospitalization in older adults discharged from hospital.

Methods

Prospective multicenter cohort study carried out with patients aged 65 and older discharged from seven acute care hospitals. The primary outcomes of the study were rehospitalization and mortality within 1 year after discharge. The study population was classified in three groups according to the anticholinergic exposure measured by the Anticholinergic Risk Scale (ARS) and Durán’s list at the time of hospital discharge: without risk (ARS/Durán = 0), low risk (ARS/Durán = 1), and high risk (ARS/Durán ≥ 2). Predictors of hospitalizations and mortality were examined using regression models adjusting for important covariates.

Results

The mean age of the 921 participants was 81.2 years (SD = 7.4 years). Prevalence of exposure to medications with anticholinergic activity ranged from 19.6% with ARS to 32.1% with Durán’s list. During the follow-up period, 30.4% of participants were hospitalized and 19.4% died. Multivariate regression analysis showed that low anticholinergic burden quantified according to Durán’s list was significantly associated with all-cause mortality (OR 1.69, 95% CI 1.02–2.82). This association was not present after adjustment when using ARS. No statistically significant association was found between anticholinergic burden and hospitalizations.

Conclusions

Taking medications with anticholinergic activity is associated with greater risk of mortality in older adults discharged from acute care hospitals. Strategies to reduce anticholinergic burden in vulnerable elders could be useful to improve health outcomes. Further research is required to assess the association between anticholinergic burden and hospitalizations in older patients.

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Acknowledgements

The CRIME project was funded by a grant of the Italian Ministry of Labor, Health and Social Policy (Bando Giovani Ricercatori 2007, convenzione n. 4). The author Marta Gutiérrez-Valencia received the grant of the Specialized Healthcare Posttraining Program from the Complejo Hospitalario de Navarra, Pamplona, Spain. The funding sources had no involvement in the design, collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Geriatrics, Complejo Hospitalario de Navarra, C/Irunlarrea 3, 31008, Pamplona, Navarra, Spain

    Marta Gutiérrez-Valencia, Nicolás Martínez-Velilla & Sergio Ladrón-Arana

  2. IdiSNa, Navarra Institute for Health Research, Pamplona, Navarra, Spain

    Marta Gutiérrez-Valencia & Nicolás Martínez-Velilla

  3. CIBER of Frailty and Healthy Aging, Madrid, Spain

    Nicolás Martínez-Velilla

  4. Department of Geriatrics, Catholic University of Rome, Rome, Italy

    Davide Liborio Vetrano & Graziano Onder

  5. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden

    Davide Liborio Vetrano

  6. Unit of Geriatric Pharmacoepidemiology, Italian National Research Center on Aging (INRCA), Cosenza, Italy

    Andrea Corsonello

  7. Scientific Direction, Italian National Research Centre on Aging, Ancona, Italy

    Fabrizia Lattanzio

Authors
  1. Marta Gutiérrez-Valencia
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  2. Nicolás Martínez-Velilla
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  3. Davide Liborio Vetrano
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  6. Sergio Ladrón-Arana
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  7. Graziano Onder
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Contributions

MGV, NMV and SLA have contributed to conception and design, analysis and interpretation of data, drafting the article and final approval of the version to be published. DLV, AC, FL and GO have contributed to conception and design, acquisition, interpretation of data, revising the text and final approval of the version to be published.

Corresponding author

Correspondence to Marta Gutiérrez-Valencia.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution and/or national research committee and with the Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Gutiérrez-Valencia, M., Martínez-Velilla, N., Vetrano, D.L. et al. Anticholinergic burden and health outcomes among older adults discharged from hospital: results from the CRIME study. Eur J Clin Pharmacol 73, 1467–1474 (2017). https://doi.org/10.1007/s00228-017-2312-5

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  • DOI: https://doi.org/10.1007/s00228-017-2312-5

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