RT Journal Article
SR Electronic
T1 Comparative Associations Between Measures of Anti-cholinergic Burden and Adverse Clinical Outcomes
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 561
OP 569
DO 10.1370/afm.2131
VO 15
IS 6
A1 Wen-Han Hsu
A1 Yu-Wen Wen
A1 Liang-Kung Chen
A1 Fei-Yuan Hsiao
YR 2017
UL http://www.annfammed.org/content/15/6/561.abstract
AB PURPOSE No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this population-based cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults.METHODS From Taiwan’s Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index - Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up. For all 3 scales, a higher score indicates greater anticholinergic burden. We used generalized estimating equations to examine the association between anticholinergic burden (ARS and ACB: grouped from 0 to ≥4; DBI-Ach: grouped as 0, 0–0.5, and 0.5–1) and adverse outcomes, and stratified individuals by age-group (aged 65–74, 75–84, and ≥85 years).RESULTS Compared with the ARS and DBI-Ach, the ACB showed the strongest, most consistent dose-response relationships with risks of all 4 adverse outcomes, particularly in people aged 65 to 84 years. For example, among those 65 to 74 years old, going from an ACB score of 1 to a score of 4 or greater, individuals’ adjusted odds ratio increased from 1.41 to 2.25 for emergency department visits; from 1.32 to 1.92 for all-cause hospitalizations; from 1.10 to 1.71 for fracture-specific hospitalizations; and from 3.13 to 10.01 for incident dementia.CONCLUSIONS Compared with the 2 other scales studied, the ACB shows good dose-response relationships between anticholinergic burden and a variety of adverse outcomes in older adults. For primary care and geriatrics clinicians, the ACB may be a helpful tool for identifying high-risk populations for interventions.