TY - JOUR
T1 - Anticholinergic Medication Burden and 5-Year Risk of Hospitalization and Death in Nursing Home Elderly Residents With Coronary Artery Disease
AU - La Carpia, Domenico
AU - Grande, Giulia
AU - Casucci, Paola
AU - Bacelli, Tiziana
AU - Bernabei, Roberto
AU - Onder, Graziano
AU - Agabiti, Nera
AU - Bartolini, Claudia
AU - Bernabei, Roberto
AU - Bettiol, Alessandra
AU - Bonassi, Stefano
AU - Caputi, Achille Patrizio
AU - Cascini, Silvia
AU - Chinellato, Alessandro
AU - Cipriani, Francesco
AU - Corrao, Giovanni
AU - Davoli, Marina
AU - Fini, Massimo
AU - Gini, Rosa
AU - Giorgianni, Francesco
AU - Kirchmayer, Ursula
AU - Lapi, Francesco
AU - Lombardi, Niccolò
AU - Lucenteforte, Ersilia
AU - Mugelli, Alessandro
AU - Onder, Graziano
AU - Rea, Federico
AU - Roberto, Giuseppe
AU - Sorge, Chiara
AU - Tari, Michele
AU - Trifirò, Gianluca
AU - Vannacci, Alfredo
AU - Vetrano, Davide Liborio
AU - Vigano', Roberto Giuseppe
AU - Vitale, Cristiana
PY - 2016
Y1 - 2016
N2 - 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.
AB - 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.
KW - Anticholinergics
KW - Health Policy
KW - Medicine (all)
KW - Nursing (all)2901 Nursing (miscellaneous)
KW - hospitalization
KW - ischemic heart disease
KW - mortality
KW - nursing home
KW - Anticholinergics
KW - Health Policy
KW - Medicine (all)
KW - Nursing (all)2901 Nursing (miscellaneous)
KW - hospitalization
KW - ischemic heart disease
KW - mortality
KW - nursing home
UR - https://publicatt.unicatt.it/handle/10807/100021
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=84992561523&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84992561523&origin=inward
U2 - 10.1016/j.jamda.2016.07.012
DO - 10.1016/j.jamda.2016.07.012
M3 - Article
SN - 1525-8610
VL - 17
SP - 1056
EP - 1059
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 11
ER -
