nach oben

Drugs & Aging

Erschienen in:

17.01.2019 | Original Research Article

Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study

verfasst von: Ariel R. Green, Liza M. Reifler, Elizabeth A. Bayliss, Linda A. Weffald, Cynthia M. Boyd

Erschienen in: Drugs & Aging | Ausgabe 3/2019

Einloggen, um Zugang zu erhalten

Abstract

Background

It is not known whether drugs with different anticholinergic ratings contribute proportionately to overall anticholinergic score.

Objectives

Our objective was to assess the risk of falls or fall-related injuries as a function of the overall anticholinergic score resulting from drugs with different anticholinergic ratings among people with impaired cognition.

Methods

This was a retrospective cohort study of adults aged ≥ 65 years with mild cognitive impairment (MCI) or dementia and two or more additional chronic conditions (N = 10,698) in an integrated delivery system. Electronic health record data, including pharmacy fills and diagnosis claims, were used to assess anticholinergic medication use, quantified using the anticholinergic cognitive burden (ACB) scale, falls and fall-related injuries.

Results

During a median follow-up of 366 days, 63% of the cohort used one or more ACB drug; 2015 (18.8%) people experienced a fall or fall-related injury. Among patients with a daily ACB score of 5, the greatest increase in risk of falls or fall-related injuries was seen when level 2 and level 3 drugs were used in combination [hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.51–2.83]. Multiple ACB level 1 drugs taken together also increased the hazard of a fall or fall-related injury (HR 1.16; 95% CI 1.03–1.32). The risk of fall or fall-related injury as a function of exposure to ACB level 2 drugs (HR 1.56; 95% CI 1.16–2.10) was higher than that for ACB level 1 or 3 drugs.

Conclusions

The same daily ACB score was associated with a different degree of risk, depending on the ACB ratings of the individual drugs comprising the score. Combinations of level 2 and level 3 drugs had the greatest risk of fall or fall-related injury relative to other individuals with the same daily ACB score. Low-potency anticholinergic drugs taken together modestly increased the hazard of a fall or fall-related injury.

Nur mit Berechtigung zugänglich

American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46. https://doi.org/10.1111/jgs.13702.CrossRef

Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med. 2000;93(9):457–62.CrossRefPubMedPubMedCentral

Wilson NM, Hilmer SN, March LM, Cameron ID, Lord SR, Seibel MJ, et al. Associations between drug burden index and falls in older people in residential aged care. J Am Geriatr Soc. 2011;59(5):875–80.CrossRefPubMed

Nishtala PS, Narayan SW, Wang T, Hilmer SN. Associations of drug burden index with falls, general practitioner visits, and mortality in older people. Pharmacoepidemiol Drug Saf. 2014;23(7):753–8.CrossRefPubMed

Dauphinot V, Faure R, Omrani S, Goutelle S, Bourguignon L, Krolak-Salmon P, et al. Exposure to anticholinergic and sedative drugs, risk of falls, and mortality: an elderly inpatient, multicenter cohort. J Clin Psychopharmacol. 2014;34(5):565–70.CrossRefPubMed

Aizenberg D, Sigler M, Weizman A, Barak Y. Anticholinergic burden and the risk of falls among elderly psychiatric inpatients: a 4-year case-control study. Int Psychogeriatr. 2002;14(3):307–10.CrossRefPubMed

Marcum ZA, Perera S, Thorpe JM, Switzer GE, Gray SL, Castle NG, et al. Anticholinergic use and recurrent falls in community-dwelling older adults: findings from the Health ABC study. Ann Pharmacother. 2015;49(11):1214–21.CrossRefPubMedPubMedCentral

Richardson K, Bennett K, Maidment ID, Fox C, Smithard D, Kenny RA. Use of medications with anticholinergic activity and self-reported injurious falls in older community-dwelling adults. J Am Geriatr Soc. 2015;63(8):1561–9.CrossRefPubMed

Zia A, Kamaruzzaman S, Myint PK, Tan MP. Anticholinergic burden is associated with recurrent and injurious falls in older individuals. Maturitas. 2016;84:32–7.CrossRefPubMed

10.

Cardwell K, Hughes CM, Ryan C. The association between anticholinergic medication burden and health related outcomes in the ‘oldest old’: a systematic review of the literature. Drugs Aging. 2015;32(10):835–48.CrossRefPubMed

11.

Salahudeen MS, Duffull SB, Nishtala PS. Impact of anticholinergic discontinuation on cognitive outcomes in older people: a systematic review. Drugs Aging. 2014;31(3):185–92.CrossRefPubMed

12.

Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175(3):401–7.CrossRefPubMedPubMedCentral

13.

Campbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, et al. The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging. 2009;4:225–33.PubMedPubMedCentral

14.

Agency for Healthcare Research and Quality. Chronic condition classification. http://www.icpsr.umich.edu/icpsrweb/content/AHRQMCC/shared-code.html. Accessed 14 Aug 2017.

15.

Amjad H, Carmichael D, Austin AM, Chang CH, Bynum JP. Continuity of care and health care utilization in older adults with dementia in fee-for-service medicare. JAMA Intern Med. 2016;176(9):1371–8.CrossRefPubMedPubMedCentral

16.

Campbell NL, Maidment I, Fox C, Khan B, Boustani M. The 2012 update to the anticholinergic cognitive burden scale. J Am Geriatr Soc. 2013;61(S1):S142–3.

17.

Campbell NL, Perkins AJ, Bradt P, Perk S, Wielage RC, Boustani MA, et al. Association of anticholinergic burden with cognitive impairment and health care utilization among a diverse ambulatory older adult population. Pharmacotherapy. 2016;36(11):1123–31.CrossRefPubMedPubMedCentral

18.

Hoffman GJ, Hays RD, Shapiro MF, Wallace SP, Ettner SL. Claims-based Identification methods and the cost of fall-related injuries among US older adults. Med Care. 2016;54(7):664–71.CrossRefPubMedPubMedCentral

19.

Salahudeen MS, Hilmer SN, Nishtala PS. Comparison of anticholinergic risk scales and associations with adverse health outcomes in older people. J Am Geriatr Soc. 2015;63(1):85–90.CrossRefPubMed

20.

Nilsson M, Eriksson J, Larsson B, Oden A, Johansson H, Lorentzon M. fall risk assessment predicts fall-related injury, hip fracture, and head injury in older adults. J Am Geriatr Soc. 2016;64(11):2242–50.CrossRefPubMed

21.

Beydoun HA, Beydoun MA, Mishra NK, Rostant OS, Zonderman AB, Eid SM. Comorbid Parkinson’s disease, falls and fractures in the 2010 National Emergency Department Sample. Parkinsonism Relat Disord. 2017;35:30–5.CrossRefPubMed

22.

Berdot S, Bertrand M, Dartigues JF, Fourrier A, Tavernier B, Ritchie K, et al. Inappropriate medication use and risk of falls—a prospective study in a large community-dwelling elderly cohort. BMC Geriatr. 2009;9:30.CrossRefPubMedPubMedCentral

23.

Alvarez CA, Mortensen EM, Makris UE, Berlowitz DR, Copeland LA, Good CB, et al. Association of skeletal muscle relaxers and antihistamines on mortality, hospitalizations, and emergency department visits in elderly patients: a nationwide retrospective cohort study. BMC Geriatr. 2015;15(1):2.CrossRefPubMedPubMedCentral

24.

Marcum ZA, Wirtz HS, Pettinger M, LaCroix AZ, Carnahan R, Cauley JA, et al. Anticholinergic medication use and falls in postmenopausal women: findings from the women’s health initiative cohort study. BMC Geriatr. 2016;16(1):76.CrossRefPubMedPubMedCentral

25.

Chatterjee S, Bali V, Carnahan RM, Chen H, Johnson ML, Aparasu RR. Anticholinergic medication use and risk of fracture in elderly adults with depression. J Am Geriatr Soc. 2016;64(7):1492–7.CrossRefPubMed

26.

Fraser LA. Effect of anticholinergic medications on falls, fracture risk, and bone mineral density over a 10-year period. Ann Pharmacother. 2014;48(8):954–61.CrossRefPubMedPubMedCentral

27.

Kao LT, Huang CY, Lin HC, Chu CM. No increased risk of fracture in patients receiving antimuscarinics for overactive bladder syndrome: a retrospective cohort study. J Clin Pharmacol. 2018;58(6):727–32.CrossRefPubMed

28.

Marcum ZA, Wirtz HS, Pettinger M, LaCroix AZ, Carnahan R, Cauley JA, et al. Anticholinergic medication use and fractures in postmenopausal women: findings from the women’s health initiative. Drugs Aging. 2015;32(9):755–63.CrossRefPubMed

29.

Moga DC, Carnahan RM, Lund BC, Pendergast JF, Wallace RB, Torner JC, et al. Risks and benefits of bladder antimuscarinics among elderly residents of Veterans Affairs Community Living Centers. J Am Med Dir Assoc. 2013;14(10):749–60.CrossRefPubMed

30.

Lackner TE, Wyman JF, McCarthy TC, Monigold M, Davey C. Randomized, placebo-controlled trial of the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired nursing home residents with urge urinary incontinence. J Am Geriatr Soc. 2008;56(5):862–70.CrossRefPubMed

31.

Hanlon JT, Semla TP, Schmader KE. Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures. J Am Geriatr Soc. 2015;63(12):e8–18.CrossRefPubMedPubMedCentral

32.

Green AR, Oh E, Hilson L, Tian J, Boyd CM. Anticholinergic burden in older adults with mild cognitive impairment. J Am Geriatr Soc. 2016;64(12):e313–4.CrossRefPubMedPubMedCentral

33.

Bhattacharya R, Chatterjee S, Carnahan RM, Aparasu RR. Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia. Am J Geriatr Pharmacother. 2011;9(6):434–41.CrossRefPubMed

34.

Chatterjee S, Mehta S, Sherer JT, Aparasu RR. Prevalence and predictors of anticholinergic medication use in elderly nursing home residents with dementia: analysis of data from the 2004 National Nursing Home Survey. Drugs Aging. 2010;27(12):987–97.CrossRefPubMed

35.

Green AR, Reifler LM, Boyd CM, Weffald LA, Bayliss EA. Medication profiles of patients with cognitive impairment and high anticholinergic burden. Drugs Aging. 2018;35(3):223–32.CrossRefPubMedPubMedCentral

36.

Parkinson L, Magin PJ, Thomson A, Byles JE, Caughey GE, Etherton-Beer C, et al. Anticholinergic burden in older women: not seeing the wood for the trees? Med J Aust. 2015;202(2):91–4.CrossRefPubMed

37.

Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716–24.CrossRefPubMed

38.

Mold JW, Hamm RM, McCarthy LH. The law of diminishing returns in clinical medicine: how much risk reduction is enough? J Am Board Fam Med. 2010;23(3):371–5.CrossRefPubMed

39.

Sonnenberg A. Diminishing returns in sequential interventions of gastroenterology. Eur J Gastroenterol Hepatol. 2008;20(5):465–8.CrossRefPubMed

Titel: Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study
verfasst von: Ariel R. Green
Liza M. Reifler
Elizabeth A. Bayliss
Linda A. Weffald
Cynthia M. Boyd
Publikationsdatum: 17.01.2019
Verlag: Springer International Publishing
Erschienen in: Drugs & Aging / Ausgabe 3/2019
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI: https://doi.org/10.1007/s40266-018-00630-z

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Positiver FIT: Die Ursache liegt nicht immer im Dickdarm

27.05.2024 Blut im Stuhl Nachrichten

Immunchemischer Stuhltest positiv, Koloskopie negativ – in solchen Fällen kann die Blutungsquelle auch weiter proximal sitzen. Ein Forschungsteam hat nachgesehen, wie häufig und in welchen Lokalisationen das der Fall ist.

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

24.05.2024 Diabetische Retinopathie Nachrichten

Möglicherweise hängt es von der Art der Diabetesmedikamente ab, wie hoch das Risiko der Betroffenen ist, dass sich sehkraftgefährdende Komplikationen verschlimmern.

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

ADT zur Radiatio nach Prostatektomie: Wenn, dann wohl länger

24.05.2024 Prostatakarzinom Nachrichten

Welchen Nutzen es trägt, wenn die Strahlentherapie nach radikaler Prostatektomie um eine Androgendeprivation ergänzt wird, hat die RADICALS-HD-Studie untersucht. Nun liegen die Ergebnisse vor. Sie sprechen für länger dauernden Hormonentzug.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Background

Objectives

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2019

Practical Regional Anesthesia Guide for Elderly Patients

Pigmentation Disorders in the Elderly

Factors to Consider in the Selection of Dopamine Agonists for Older Persons with Parkinson’s Disease

Higher Fit-fOR-The-Aged (FORTA) Scores Comprising Medication Errors are Associated with Impaired Cognitive and Physical Function Tests in the VALFORTA Trial

Clinical Assessment and Management of Foot and Ankle Osteoarthritis: A Review of Current Evidence and Focus on Pharmacological Treatment

Prescriber Implementation of STOPP/START Recommendations for Hospitalised Older Adults: A Comparison of a Pharmacist Approach and a Physician Approach