Key result
Cumulative use of multiple low-potency anticholinergics increased ED visit risk (aOR 2.05; 95% CI 1.99-2.12), while high-potency anticholinergics increased incident dementia risk (aOR 9.15).
Why the study?
Although anticholinergic burden indicates suboptimal prescribing in the elderly, no research was available concerning the effect of different score compositions on adverse outcomes under the same total anticholinergic burden.
Do different combinations of medications with anticholinergic properties have different impacts on adverse outcomes in the elderly under the same total anticholinergic burden?
Cohort (n=116,043)
Do different combinations of medications with anticholinergic properties have different impacts on adverse outcomes in the elderly under the same total anticholinergic burden?
Odds Ratio: 2.05 (95% CI 1.99–2.12)
In the elderly, the quantity of low-potency anticholinergics drives the risk of ED visits and all-cause hospitalizations, whereas the use of high-potency anticholinergics drives the risk of fracture-specific hospitalizations and incident dementia.
Different anticholinergic combinations may differentially affect elderly outcomes; leaves open whether composition-specific scoring refines risk assessment.
The cumulative effect of multiple pharmaceutics with anticholinergic properties (i.e., anticholinergic burden), can serve as an indicator of suboptimal prescribing in the elderly. Yet, no research is available concerning the effect of different compositions of score on adverse outcomes under the same anticholinergic burden. This population-based cohort study investigated whether different combinations of medications with anticholinergic properties have different impacts on adverse outcomes in the elderly using the Anticholinergic Risk Scale (ARS) and Anticholinergic Cognitive Burden Scale (ACB) scores. We included 116,043 people aged 65 years and older from Taiwan's Longitudinal Health Insurance Database and measured their monthly anticholinergic burden over a 10-year follow-up period (from January 1, 2002, to December 31, 2011). We analyzed the association between different anticholinergic score compositions and adverse outcomes (emergency department visits, all-cause hospitalizations, fracture-specific hospitalizations, and incident dementia) via generalized estimating equations. Cumulative effects of multiple medications with low anticholinergic activity were associated with a greater risk for emergency department visits and all-cause hospitalizations (emergency department visits for 65-74 year olds (y/o): ACB 1 + 1 + 1, adjusted odds ratio (aOR) 2.05 (1.99-2.12); ACB 1 + 2, aOR 2.04 (1.91-2.17); and ACB 3, aOR 1.62 (1.57-1.66)). In contrast, using medications with greater potency had a greater impact on central adverse outcomes (incident dementia for 65-74 y/o: ACB 1 + 1 + 1, aOR 3.30 (2.84-3.84); ACB 1 + 2, aOR 5.84 (4.59-7.41); and ACB 3, aOR 9.15 (8.38-9.99)). The quantity of anticholinergics (even with low score) an older person used matters in risk of emergency department visit and all-cause hospitalization but the potency of anticholinergics (i.e., those with high score) matters in risk of fracture-specific hospitalization and incident dementia.
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Hsu et al. (2021) conducted a cohort in Anticholinergic burden (n=116,043). Different compositions of medications with anticholinergic properties was evaluated on Emergency department visits for 65-74 year olds (ACB 1 + 1 + 1) (aOR 2.05, 95% CI 1.99-2.12). Cumulative use of multiple low-potency anticholinergics increased ED visit risk (aOR 2.05; 95% CI 1.99-2.12), while high-potency anticholinergics increased incident dementia risk (aOR 9.15).
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