Anticholinergic Medication Burden and 5-Year Risk of Hospitalization and Death in Nursing Home Elderly Residents With Coronary Artery Disease

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Vetrano, Davide L.Karolinska Institutet,Stockholms universitet,Centrum för forskning om äldre och åldrande (ARC), (tills m KI),Catholic University of Rome, Italy (author)

Anticholinergic Medication Burden and 5-Year Risk of Hospitalization and Death in Nursing Home Elderly Residents With Coronary Artery Disease

Article/chapterEnglish2016

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Elsevier BV,2016
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LIBRIS-ID:oai:DiVA.org:su-137748
https://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-137748URI
https://doi.org/10.1016/j.jamda.2016.07.012DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:134666612URI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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Objectives: To assess the association of the anticholinergic medication burden with hospitalization and mortality in nursing home elderly patients and to investigate the role of coronary artery disease (CAD). Design: Longitudinal (5-year) retrospective observational study. Setting: Nursing homes in Italy. Participants: A total of 3761 nursing home older residents. Measurements: A comprehensive clinical and functional assessment was carried out through the interRAI long-term care facility instrument. The anticholinergic burden was assessed through the anticholinergic cognitive burden (ACB) scale. Occurrence of hospitalization/all-cause mortality was the primary composite outcome. First hospitalization and all-cause mortality were the secondary outcomes of the study. Hazard ratios (HRs) and subdistribution HRs were obtained through Cox and competing risk (death as competing event for hospitalization) models. Results: Within the sample (mean age 83 +/- 7 years; 72% females) the incidence rate of the primary outcome was 10/100 person-year. After adjusting for potential confounders and compared with participants with an ACB of 0, those with an ACB of 1 [HR 1.46; 95% confidence interval (CI) 1.12-1.90] and ABC of 2+ (HR 1.41; 95% CI 1.11-1.79) presented an increased risk of developing the primary outcome. After stratification, the risk for the primary outcome increased along with the anticholinergic burden, only for participants affected by CAD (HR 1.53; 95% CI 0.94-2.50 and HR 1.71; 95% CI 1.09-2.68 for the ACB of 1 and ACB of 2+ groups). An ACB score of 2+ was marginally associated with first hospitalization, considering death as a competing risk, only for those with CAD (subdistribution HR 3.47; 95% CI 0.99-12.3). Conclusions: Anticholinergic medication burden is associated to hospitalization and all-cause mortality in institutionalized older adults. CAD increases such risk. The effectiveness and safety profile of complex drug regimens should be reconsidered in this population.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Annan medicin och hälsovetenskap Gerontologi, medicinsk/hälsovetenskaplig inriktning hsv//swe
MEDICAL AND HEALTH SCIENCES Other Medical and Health Sciences Gerontology, specialising in Medical and Health Sciences hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Geriatrik hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Geriatrics hsv//eng
Anticholinergics
nursing home
ischemic heart disease
hospitalization
mortality

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La Carpia, Domenico (author)
Grande, GiuliaKarolinska Institutet,Stockholms universitet,Centrum för forskning om äldre och åldrande (ARC), (tills m KI),University of Milan, Italy (author)
Casucci, Paola (author)
Bacelli, Tiziana (author)
Bernabei, Roberto (author)
Onder, Graziano (author)
Stockholms universitetCentrum för forskning om äldre och åldrande (ARC), (tills m KI) (creator_code:org_t)

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In:Journal of the American Medical Directors Association: Elsevier BV17:11, s. 1056-10591525-86101538-9375

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Other Medical an ...; and Gerontology spec ...

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