Anticholinergic Burden and Emergency Department Visits in Older Adults
| Scale and Score | Emergency Department Visits | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Aged 65–74 Years (n = 287,693) | Aged 75–84 Years (n = 137,858) | Aged ≥85 Years (n = 16,830) | |||||||
| No. | aORa (95% CI) | P Value | No. | aORa (95% CI) | P Value | No. | aORa (95% CI) | P Value | |
| ARSb | |||||||||
| 0 (ref) | 214,635 | 1.00 | – | 101,410 | 1.00 | – | 12,926 | 1.00 | – |
| 1 | 22,426 | 1.90 (1.86–1.95) | <.001 | 13,014 | 1.85 (1.79–1.91) | <.001 | 1,590 | 1.61 (1.47–1.76) | <.001 |
| 2 | 22,753 | 1.55 (1.51–1.59) | <.001 | 10,359 | 1.54 (1.48–1.60) | <.001 | 1,047 | 1.34 (1.19–1.51) | <.001 |
| 3 | 17,616 | 1.65 (1.61–1.70) | <.001 | 8,351 | 1.56 (1.50–1.62) | <.001 | 827 | 1.38 (1.23–1.54) | <.001 |
| ≥4 | 10,263 | 2.04 (1.97–2.11) | <.001 | 4,724 | 1.94 (1.85–2.03) | <.001 | 440 | 1.73 (1.50–2.01) | <.001 |
| ACBb | |||||||||
| 0 (ref) | 140,058 | 1.00 | – | 65,016 | 1.00 | – | 9,143 | 1.00 | – |
| 1 | 64,684 | 1.41 (1.37–1.45) | <.001 | 30,612 | 1.38 (1.35–1.41) | <.001 | 3,432 | 1.35 (1.28–1.44) | <.001 |
| 2 | 32,822 | 1.71 (1.66–1.75) | <.001 | 16,287 | 1.63 (1.59–1.68) | <.001 | 1,776 | 1.49 (1.38–1.61) | <.001 |
| 3 | 23,915 | 1.82 (1.78–1.87) | <.001 | 12,375 | 1.74 (1.69–1.79) | <.001 | 1,251 | 1.59 (1.46–1.74) | <.001 |
| ≥4 | 26,214 | 2.25 (2.19–2.31) | <.001 | 13,568 | 2.07 (2.00–2.14) | <.001 | 1,228 | 1.69 (1.54–1.85) | <.001 |
| DBI-Achc | |||||||||
| 0 (ref) | 214,636 | 1.00 | – | 101,411 | 1.00 | – | 12,926 | 1.00 | – |
| 0< score ≤0.5 | 56,873 | 1.68 (1.66–1.70) | <.001 | 28,900 | 1.60 (1.57–1.63) | <.001 | 3,110 | 1.55 (1.47–1.64) | <.001 |
| 0.5< score ≤1 | 16,184 | 2.02 (1.97–2.07) | <.001 | 7,547 | 1.87 (1.80–1.93) | <.001 | 794 | 1.98 (1.79–2.19) | <.001 |
aOR = adjusted odds ratio; ARS = Anticholinergic Risk Scale; ACB = Anticholinergic Cognitive Burden scale; DBI-Ach = Drug Burden Index - Anticholinergic component; ref=reference group.
Note: In multivariate generalized estimating equation models. Total sample for analysis was 442,381.
↵a Models were adjusted for sex and time-varying comorbidities (annually measured by Charlson Comorbidity Index; higher index indicates more comorbidities). For the ARS and ACB scales, we further adjusted defined daily dose of drugs with anticholinergic properties in the models to compare among the 3 scales.
↵b ARS and ACB scores were calculated as the sum of the rankings for all prescribed drugs, with higher scores indicating greater anticholinergic burden.
↵c DBI-Ach score ranges from 0 to 1, with 0.5 indicating that an individual is exposed to an anticholinergic medication at the minimum recommended daily dose.