Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation

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

doi:10.1016/j.amjopharm.2012.06.003

Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation

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

Woodend Hospital

Research output: Contribution to journal › Article › peer-review

28 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 language	English
Pages (from-to)	251-7
Number of pages	7
Journal	The American journal of geriatric pharmacotherapy
Volume	10
Issue number	4
Early online date	13 Jul 2012
DOIs	https://doi.org/10.1016/j.amjopharm.2012.06.003
Publication status	Published - Aug 2012

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

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@article{277f94925b13479ca3589075f6aaf407,

title = "Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation",

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.",

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",

author = "Sejlo Koshoedo and Soiza, {Roy L} and Rajib Purkayastha and Mangoni, {Arduino A}",

year = "2012",

month = aug,

doi = "10.1016/j.amjopharm.2012.06.003",

language = "English",

volume = "10",

pages = "251--7",

journal = "The American journal of geriatric pharmacotherapy",

issn = "1876-7761",

number = "4",

}

TY - JOUR

T1 - Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation

AU - Koshoedo, Sejlo

AU - Soiza, Roy L

AU - Purkayastha, Rajib

AU - Mangoni, Arduino A

PY - 2012/8

Y1 - 2012/8

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.

AB - 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.

KW - Activities of Daily Living

KW - Aged

KW - Aged, 80 and over

KW - Cholinergic Antagonists

KW - Cognition Disorders

KW - Cohort Studies

KW - Comorbidity

KW - Female

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

U2 - 10.1016/j.amjopharm.2012.06.003

DO - 10.1016/j.amjopharm.2012.06.003

M3 - Article

C2 - 22795433

SN - 1876-7761

VL - 10

SP - 251

EP - 257

JO - The American journal of geriatric pharmacotherapy

JF - The American journal of geriatric pharmacotherapy

IS - 4

ER -

Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation

Abstract

Keywords

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