Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation

Sejlo Koshoedo, Roy L Soiza, Rajib Purkayastha, Arduino A Mangoni

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

BACKGROUND: Medications with anticholinergic (antimuscarinic) effects negatively affect physical and cognitive function in community-dwelling older patients. However, it is unknown if anticholinergic drugs exert detrimental effects in older patients undergoing rehabilitation.

OBJECTIVE: The purpose of our study was to assess the effect of anticholinergic drug exposure on functional outcomes in older patients undergoing rehabilitation. We speculated that higher anticholinergic drug exposure would be associated with reduced functional outcomes in this group.

METHODS: Data on clinical characteristics, full medication, anticholinergic drug exposure (total number of anticholinergic drugs [tAD] and Anticholinergic Risk Scale [ARS] score), and Barthel index (BI) score were collected on admission and discharge in a consecutive series of 117 older patients (age 79 [7] years) admitted to the orthopaedic rehabilitation unit of a teaching hospital between July 2010 and March 2011. Outcome measures were BI changes (BI on discharge - BI on admission) during rehabilitation (primary outcome) and length of stay (secondary outcome).

RESULTS: Anticholinergic drugs were prescribed in 38 patients (32.5%). Median and interquartile range for tAD = 0 (0-1); for ARS = 0 (0-1). Poisson regression showed that higher tAD (incidence rate ratio [IRR] = 0.92; 95% CI, 0.88-0.97; P = 0.003) and ARS scores (IRR = 0.97; 95% CI, 0.95-0.99; P = 0.008) on admission independently predicted lower BI changes. Being a woman (IRR = 0.87; 95% CI, 0.78-0.97; P = 0.01), lower Abbreviated Mental Test scores (IRR = 0.94; 95% CI, 0.91-0.97; P < 0.001), and lower BI on admission (IRR = 0.98; 95% CI, 0.97-0.98; P < 0.001), but not tAD or ARS scores, independently predicted increasing length of stay.

CONCLUSIONS: Higher anticholinergic drug exposure on admission independently predicts reduced functional outcomes, but not length of stay, in older patients undergoing orthopaedic rehabilitation.

Original languageEnglish
Pages (from-to)251-7
Number of pages7
JournalThe American journal of geriatric pharmacotherapy
Volume10
Issue number4
Early online date13 Jul 2012
DOIs
Publication statusPublished - Aug 2012

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Cholinergic Antagonists
Orthopedics
Rehabilitation
Pharmaceutical Preparations
Incidence
Length of Stay
Independent Living
Intelligence Tests
Muscarinic Antagonists
Teaching Hospitals
Cognition

Keywords

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Cholinergic Antagonists
  • Cognition Disorders
  • Cohort Studies
  • Comorbidity
  • Female
  • Geriatric Assessment
  • Hospitals, Teaching
  • Humans
  • Length of Stay
  • Male
  • Muscarinic Antagonists
  • Musculoskeletal Diseases
  • Poisson Distribution
  • Psychiatric Status Rating Scales
  • Scotland
  • Sex Characteristics
  • Surveys and Questionnaires
  • Journal Article

Cite this

Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation. / Koshoedo, Sejlo; Soiza, Roy L; Purkayastha, Rajib; Mangoni, Arduino A.

In: The American journal of geriatric pharmacotherapy, Vol. 10, No. 4, 08.2012, p. 251-7.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Medications with anticholinergic (antimuscarinic) effects negatively affect physical and cognitive function in community-dwelling older patients. However, it is unknown if anticholinergic drugs exert detrimental effects in older patients undergoing rehabilitation.OBJECTIVE: The purpose of our study was to assess the effect of anticholinergic drug exposure on functional outcomes in older patients undergoing rehabilitation. We speculated that higher anticholinergic drug exposure would be associated with reduced functional outcomes in this group.METHODS: Data on clinical characteristics, full medication, anticholinergic drug exposure (total number of anticholinergic drugs [tAD] and Anticholinergic Risk Scale [ARS] score), and Barthel index (BI) score were collected on admission and discharge in a consecutive series of 117 older patients (age 79 [7] years) admitted to the orthopaedic rehabilitation unit of a teaching hospital between July 2010 and March 2011. Outcome measures were BI changes (BI on discharge - BI on admission) during rehabilitation (primary outcome) and length of stay (secondary outcome).RESULTS: Anticholinergic drugs were prescribed in 38 patients (32.5{\%}). Median and interquartile range for tAD = 0 (0-1); for ARS = 0 (0-1). Poisson regression showed that higher tAD (incidence rate ratio [IRR] = 0.92; 95{\%} CI, 0.88-0.97; P = 0.003) and ARS scores (IRR = 0.97; 95{\%} CI, 0.95-0.99; P = 0.008) on admission independently predicted lower BI changes. Being a woman (IRR = 0.87; 95{\%} CI, 0.78-0.97; P = 0.01), lower Abbreviated Mental Test scores (IRR = 0.94; 95{\%} CI, 0.91-0.97; P < 0.001), and lower BI on admission (IRR = 0.98; 95{\%} CI, 0.97-0.98; P < 0.001), but not tAD or ARS scores, independently predicted increasing length of stay.CONCLUSIONS: Higher anticholinergic drug exposure on admission independently predicts reduced functional outcomes, but not length of stay, in older patients undergoing orthopaedic rehabilitation.",
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AU - Koshoedo, Sejlo

AU - Soiza, Roy L

AU - Purkayastha, Rajib

AU - Mangoni, Arduino A

N1 - Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

PY - 2012/8

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N2 - BACKGROUND: Medications with anticholinergic (antimuscarinic) effects negatively affect physical and cognitive function in community-dwelling older patients. However, it is unknown if anticholinergic drugs exert detrimental effects in older patients undergoing rehabilitation.OBJECTIVE: The purpose of our study was to assess the effect of anticholinergic drug exposure on functional outcomes in older patients undergoing rehabilitation. We speculated that higher anticholinergic drug exposure would be associated with reduced functional outcomes in this group.METHODS: Data on clinical characteristics, full medication, anticholinergic drug exposure (total number of anticholinergic drugs [tAD] and Anticholinergic Risk Scale [ARS] score), and Barthel index (BI) score were collected on admission and discharge in a consecutive series of 117 older patients (age 79 [7] years) admitted to the orthopaedic rehabilitation unit of a teaching hospital between July 2010 and March 2011. Outcome measures were BI changes (BI on discharge - BI on admission) during rehabilitation (primary outcome) and length of stay (secondary outcome).RESULTS: Anticholinergic drugs were prescribed in 38 patients (32.5%). Median and interquartile range for tAD = 0 (0-1); for ARS = 0 (0-1). Poisson regression showed that higher tAD (incidence rate ratio [IRR] = 0.92; 95% CI, 0.88-0.97; P = 0.003) and ARS scores (IRR = 0.97; 95% CI, 0.95-0.99; P = 0.008) on admission independently predicted lower BI changes. Being a woman (IRR = 0.87; 95% CI, 0.78-0.97; P = 0.01), lower Abbreviated Mental Test scores (IRR = 0.94; 95% CI, 0.91-0.97; P < 0.001), and lower BI on admission (IRR = 0.98; 95% CI, 0.97-0.98; P < 0.001), but not tAD or ARS scores, independently predicted increasing length of stay.CONCLUSIONS: Higher anticholinergic drug exposure on admission independently predicts reduced functional outcomes, but not length of stay, in older patients undergoing orthopaedic rehabilitation.

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KW - Cholinergic Antagonists

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KW - Cohort Studies

KW - Comorbidity

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KW - Geriatric Assessment

KW - Hospitals, Teaching

KW - Humans

KW - Length of Stay

KW - Male

KW - Muscarinic Antagonists

KW - Musculoskeletal Diseases

KW - Poisson Distribution

KW - Psychiatric Status Rating Scales

KW - Scotland

KW - Sex Characteristics

KW - Surveys and Questionnaires

KW - Journal Article

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JO - The American journal of geriatric pharmacotherapy

JF - The American journal of geriatric pharmacotherapy

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