The relationship between total anticholinergic burden (ACB) and early in-patient hospital mortality and length of stay in the oldest old aged 90 years and over admitted with an acute illness

Andrew C Kidd, Patrick Musonda, Roy L Soiza, Catherine Butchart, Claire J Lunt, Yogish Pai, Yasir Hameed, Chris Fox, John F Potter, Phyo Kyaw Myint

Research output: Contribution to journalArticle

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Abstract

The use of prescription drugs in older people is high and many commonly prescribed drugs have anticholinergic effects. We examined the relationship between ACB on mortality and in-patient length of stay in the oldest old hospitalised population. This was a retrospective analysis of prospective audit using hospital audit data from acute medical admissions in three hospitals in England and Scotland. Baseline use of possible or definite anticholinergics was determined according to the Anticholinergic Cognitive Burden Scale. The main outcome measures were decline in-hospital mortality, early in-hospital mortality at 3- and 7-days and in-patient length of stay. A total of 419 patients (including 65 patients with known dementia) were included [median age=92.9, inter-quartile range (IQR) 91.4-95.1 years]. 256 (61.1%) were taking anticholinergic medications. Younger age, greater number of pre-morbid conditions, ischemic heart disease, number of medications, higher urea and creatinine levels were significantly associated with higher total ACB burden on univariate regression analysis. There were no significant differences observed in terms of in-patient mortality, in-patient hospital mortality within 3- and 7-days and likelihood of prolonged length of hospital stay between ACB categories. Compared to those without cardiovascular disease, patients with cardiovascular disease showed similar outcome regardless of ACB load (either =0 or >0 ACB). We found no association between ACB and early (within 3- and 7-days) and in-patient mortality and hospital length of stay outcomes in this cohort of oldest old in the acute medical admission setting.
Original languageEnglish
Pages (from-to)155-161
Number of pages7
JournalArchives of Gerontology and Geriatrics
Volume59
Issue number1
Early online date5 Feb 2014
DOIs
Publication statusPublished - Jul 2014

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Cholinergic Antagonists
Hospital Mortality
Length of Stay
illness
mortality
medication
audit
drug
Disease
Mortality
Cardiovascular Diseases
heart disease
dementia
regression analysis
Prescription Drugs
Scotland
England
Myocardial Ischemia
Dementia
Urea

Keywords

  • ACB
  • oldest old
  • mortality
  • length of stay

Cite this

The relationship between total anticholinergic burden (ACB) and early in-patient hospital mortality and length of stay in the oldest old aged 90 years and over admitted with an acute illness. / Kidd, Andrew C; Musonda, Patrick; Soiza, Roy L; Butchart, Catherine; Lunt, Claire J; Pai, Yogish; Hameed, Yasir; Fox, Chris; Potter, John F; Myint, Phyo Kyaw.

In: Archives of Gerontology and Geriatrics, Vol. 59, No. 1, 07.2014, p. 155-161.

Research output: Contribution to journalArticle

Kidd, Andrew C ; Musonda, Patrick ; Soiza, Roy L ; Butchart, Catherine ; Lunt, Claire J ; Pai, Yogish ; Hameed, Yasir ; Fox, Chris ; Potter, John F ; Myint, Phyo Kyaw. / The relationship between total anticholinergic burden (ACB) and early in-patient hospital mortality and length of stay in the oldest old aged 90 years and over admitted with an acute illness. In: Archives of Gerontology and Geriatrics. 2014 ; Vol. 59, No. 1. pp. 155-161.
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AU - Musonda, Patrick

AU - Soiza, Roy L

AU - Butchart, Catherine

AU - Lunt, Claire J

AU - Pai, Yogish

AU - Hameed, Yasir

AU - Fox, Chris

AU - Potter, John F

AU - Myint, Phyo Kyaw

N1 - Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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N2 - The use of prescription drugs in older people is high and many commonly prescribed drugs have anticholinergic effects. We examined the relationship between ACB on mortality and in-patient length of stay in the oldest old hospitalised population. This was a retrospective analysis of prospective audit using hospital audit data from acute medical admissions in three hospitals in England and Scotland. Baseline use of possible or definite anticholinergics was determined according to the Anticholinergic Cognitive Burden Scale. The main outcome measures were decline in-hospital mortality, early in-hospital mortality at 3- and 7-days and in-patient length of stay. A total of 419 patients (including 65 patients with known dementia) were included [median age=92.9, inter-quartile range (IQR) 91.4-95.1 years]. 256 (61.1%) were taking anticholinergic medications. Younger age, greater number of pre-morbid conditions, ischemic heart disease, number of medications, higher urea and creatinine levels were significantly associated with higher total ACB burden on univariate regression analysis. There were no significant differences observed in terms of in-patient mortality, in-patient hospital mortality within 3- and 7-days and likelihood of prolonged length of hospital stay between ACB categories. Compared to those without cardiovascular disease, patients with cardiovascular disease showed similar outcome regardless of ACB load (either =0 or >0 ACB). We found no association between ACB and early (within 3- and 7-days) and in-patient mortality and hospital length of stay outcomes in this cohort of oldest old in the acute medical admission setting.

AB - The use of prescription drugs in older people is high and many commonly prescribed drugs have anticholinergic effects. We examined the relationship between ACB on mortality and in-patient length of stay in the oldest old hospitalised population. This was a retrospective analysis of prospective audit using hospital audit data from acute medical admissions in three hospitals in England and Scotland. Baseline use of possible or definite anticholinergics was determined according to the Anticholinergic Cognitive Burden Scale. The main outcome measures were decline in-hospital mortality, early in-hospital mortality at 3- and 7-days and in-patient length of stay. A total of 419 patients (including 65 patients with known dementia) were included [median age=92.9, inter-quartile range (IQR) 91.4-95.1 years]. 256 (61.1%) were taking anticholinergic medications. Younger age, greater number of pre-morbid conditions, ischemic heart disease, number of medications, higher urea and creatinine levels were significantly associated with higher total ACB burden on univariate regression analysis. There were no significant differences observed in terms of in-patient mortality, in-patient hospital mortality within 3- and 7-days and likelihood of prolonged length of hospital stay between ACB categories. Compared to those without cardiovascular disease, patients with cardiovascular disease showed similar outcome regardless of ACB load (either =0 or >0 ACB). We found no association between ACB and early (within 3- and 7-days) and in-patient mortality and hospital length of stay outcomes in this cohort of oldest old in the acute medical admission setting.

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