Associations between different measures of anticholinergic drug exposure and Barthel Index in older hospitalized patients

Clare V. Bostock, Roy L Soiza, Arduino A. Mangoni

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

OBJECTIVE: To compare associations between four measures of anticholinergic exposure (anticholinergic risk scale, ARS; anticholinergic drug burden, DBAC; number and use versus no use of anticholinergic drugs), Barthel Index (BI, physical function) and Abbreviated Mental Test (AMT, cognitive function) on admission in older hospitalized patients.

METHODS: Prospective observational study of a consecutive series of 271 older patients (age 83 ± 7 years) from community-dwelling and institutionalized settings, admitted to an acute geriatric admission unit between 28 September 2011 and 18 December 2011. The main outcome measures were BI quartiles (primary outcome) and AMT (secondary outcome) on admission.

RESULTS: Anticholinergic prevalence was 47%. Multinomial logistic regression showed higher DBAC was associated with a greater risk of being in the lower BI quartiles versus highest BI quartile (Q4). This risk was significant for Q3 (p = 0.04) and Q2 (p = 0.02) but not for Q1 (p = 0.06). A greater number of anticholinergic drugs was associated with a higher risk of being in Q2 (p = 0.02). This risk was not significant for either Q3 (p = 0.10) or Q1 (p = 0.06). No significant associations were observed either with use of anticholinergic medication or with ARS and BI quartiles. AMT did not show independent associations with any of the four measures of anticholinergic exposure.

CONCLUSION: In older hospitalized patients, DBAC and some crude measures of anticholinergic exposure, but not ARS, showed independent associations with lower BI, but not AMT. These results highlight differences between various measures of anticholinergic drug exposure when studying their associations with functional status.

Original languageEnglish
Pages (from-to)235-245
Number of pages11
JournalTherapeutic Advances in Drug Safety
Volume4
Issue number6
Early online date4 Sep 2013
DOIs
Publication statusPublished - Dec 2013

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Cholinergic Antagonists
Pharmaceutical Preparations
Independent Living
Intelligence Tests
Geriatrics
Cognition
Observational Studies
Logistic Models
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • aged
  • anticholinergic risk scale
  • barthel index
  • cholinergic antagonists
  • drug burden index
  • drug toxicity
  • frail elderly
  • muscarinic antagonists

Cite this

Associations between different measures of anticholinergic drug exposure and Barthel Index in older hospitalized patients. / Bostock, Clare V.; Soiza, Roy L; Mangoni, Arduino A.

In: Therapeutic Advances in Drug Safety, Vol. 4, No. 6, 12.2013, p. 235-245.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To compare associations between four measures of anticholinergic exposure (anticholinergic risk scale, ARS; anticholinergic drug burden, DBAC; number and use versus no use of anticholinergic drugs), Barthel Index (BI, physical function) and Abbreviated Mental Test (AMT, cognitive function) on admission in older hospitalized patients.METHODS: Prospective observational study of a consecutive series of 271 older patients (age 83 ± 7 years) from community-dwelling and institutionalized settings, admitted to an acute geriatric admission unit between 28 September 2011 and 18 December 2011. The main outcome measures were BI quartiles (primary outcome) and AMT (secondary outcome) on admission.RESULTS: Anticholinergic prevalence was 47{\%}. Multinomial logistic regression showed higher DBAC was associated with a greater risk of being in the lower BI quartiles versus highest BI quartile (Q4). This risk was significant for Q3 (p = 0.04) and Q2 (p = 0.02) but not for Q1 (p = 0.06). A greater number of anticholinergic drugs was associated with a higher risk of being in Q2 (p = 0.02). This risk was not significant for either Q3 (p = 0.10) or Q1 (p = 0.06). No significant associations were observed either with use of anticholinergic medication or with ARS and BI quartiles. AMT did not show independent associations with any of the four measures of anticholinergic exposure.CONCLUSION: In older hospitalized patients, DBAC and some crude measures of anticholinergic exposure, but not ARS, showed independent associations with lower BI, but not AMT. These results highlight differences between various measures of anticholinergic drug exposure when studying their associations with functional status.",
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author = "Bostock, {Clare V.} and Soiza, {Roy L} and Mangoni, {Arduino A.}",
note = "Acknowledgements The authors thank Research Nurse Hazel Clark for data collection. Funding This work was supported by an Endowment Grant from NHS Grampian and sponsored by NHS Grampian Research and Development. Dr Soiza’s contribution is funded by an NHS Research Scotland (NRS) Career Research Fellowship. The funder/sponsor had no role in study design, conduct or data-analysis.",
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T1 - Associations between different measures of anticholinergic drug exposure and Barthel Index in older hospitalized patients

AU - Bostock, Clare V.

AU - Soiza, Roy L

AU - Mangoni, Arduino A.

N1 - Acknowledgements The authors thank Research Nurse Hazel Clark for data collection. Funding This work was supported by an Endowment Grant from NHS Grampian and sponsored by NHS Grampian Research and Development. Dr Soiza’s contribution is funded by an NHS Research Scotland (NRS) Career Research Fellowship. The funder/sponsor had no role in study design, conduct or data-analysis.

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N2 - OBJECTIVE: To compare associations between four measures of anticholinergic exposure (anticholinergic risk scale, ARS; anticholinergic drug burden, DBAC; number and use versus no use of anticholinergic drugs), Barthel Index (BI, physical function) and Abbreviated Mental Test (AMT, cognitive function) on admission in older hospitalized patients.METHODS: Prospective observational study of a consecutive series of 271 older patients (age 83 ± 7 years) from community-dwelling and institutionalized settings, admitted to an acute geriatric admission unit between 28 September 2011 and 18 December 2011. The main outcome measures were BI quartiles (primary outcome) and AMT (secondary outcome) on admission.RESULTS: Anticholinergic prevalence was 47%. Multinomial logistic regression showed higher DBAC was associated with a greater risk of being in the lower BI quartiles versus highest BI quartile (Q4). This risk was significant for Q3 (p = 0.04) and Q2 (p = 0.02) but not for Q1 (p = 0.06). A greater number of anticholinergic drugs was associated with a higher risk of being in Q2 (p = 0.02). This risk was not significant for either Q3 (p = 0.10) or Q1 (p = 0.06). No significant associations were observed either with use of anticholinergic medication or with ARS and BI quartiles. AMT did not show independent associations with any of the four measures of anticholinergic exposure.CONCLUSION: In older hospitalized patients, DBAC and some crude measures of anticholinergic exposure, but not ARS, showed independent associations with lower BI, but not AMT. These results highlight differences between various measures of anticholinergic drug exposure when studying their associations with functional status.

AB - OBJECTIVE: To compare associations between four measures of anticholinergic exposure (anticholinergic risk scale, ARS; anticholinergic drug burden, DBAC; number and use versus no use of anticholinergic drugs), Barthel Index (BI, physical function) and Abbreviated Mental Test (AMT, cognitive function) on admission in older hospitalized patients.METHODS: Prospective observational study of a consecutive series of 271 older patients (age 83 ± 7 years) from community-dwelling and institutionalized settings, admitted to an acute geriatric admission unit between 28 September 2011 and 18 December 2011. The main outcome measures were BI quartiles (primary outcome) and AMT (secondary outcome) on admission.RESULTS: Anticholinergic prevalence was 47%. Multinomial logistic regression showed higher DBAC was associated with a greater risk of being in the lower BI quartiles versus highest BI quartile (Q4). This risk was significant for Q3 (p = 0.04) and Q2 (p = 0.02) but not for Q1 (p = 0.06). A greater number of anticholinergic drugs was associated with a higher risk of being in Q2 (p = 0.02). This risk was not significant for either Q3 (p = 0.10) or Q1 (p = 0.06). No significant associations were observed either with use of anticholinergic medication or with ARS and BI quartiles. AMT did not show independent associations with any of the four measures of anticholinergic exposure.CONCLUSION: In older hospitalized patients, DBAC and some crude measures of anticholinergic exposure, but not ARS, showed independent associations with lower BI, but not AMT. These results highlight differences between various measures of anticholinergic drug exposure when studying their associations with functional status.

KW - aged

KW - anticholinergic risk scale

KW - barthel index

KW - cholinergic antagonists

KW - drug burden index

KW - drug toxicity

KW - frail elderly

KW - muscarinic antagonists

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DO - 10.1177/2042098613500689

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JO - Therapeutic Advances in Drug Safety

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