Polypharmacy and cumulative anticholinergic burden in older adults hospitalized with fall

• Published in: Aging medicine Vol. 6; no. 2; pp. 116 - 123
• Main Authors: Wong, Ho Lun, Weaver, Claire, Marsh, Lauren, Mon, Khine Oo, Dapito, John M., Amin, Fouad R., Chauhan, Rahul, Mandal, Amit K. J., Missouris, Constantinos G.
• Format: Journal Article
• Language: English
• Published: Australia John Wiley & Sons, Inc 01.06.2023; John Wiley and Sons Inc; Wiley
• Subjects: Age; anticholinergic burden; Anticholinergics; Audit departments; Blood pressure; Cardiac arrhythmia; Chronic illnesses; Chronic obstructive pulmonary disease; Cognitive ability; Comorbidity; Dementia; Diabetes; fall; Heart failure; Heart rate; Hospitalization; Hospitals; Hypertension; Kidney diseases; older; Older people; Original; Orthostatic hypotension; outcomes; Patients; Polypharmacy; Statistical analysis; older; fall; anticholinergic burden; outcomes; polypharmacy
• ISSN: 2475-0360; 2475-0360
• DOI: 10.1002/agm2.12250

Introduction Polypharmacy is a growing phenomenon associated with adverse effects in older adults. We assessed the potential confounding effects of cumulative anticholinergic burden (ACB) in patients who were hospitalized with falls. Methods A noninterventional, prospective cohort study of unselected, acute admissions aged ≥ 65 years. Data were derived from electronic patient health records. Results were analyzed to determine the frequency of polypharmacy and degree of ACB and their relationship to falls risk. Primary outcomes were polypharmacy, defined as prescription of 5 or more regular oral medications, and ACB score. Key Results Four hundred eleven (411) consecutive subjects were included, mean age 83.8 ± 8.0 years: 40.6% men. There were 38.4% patients who were admitted with falls. Incidence of polypharmacy was 80.8%, (88.0% and 76.3% among those admitted with and without fall, respectively). Incidence of ACB score of 0, 1, 2, ≥ 3 was 38.7%, 20.9%, 14.6%, and 25.8%, respectively. On multivariate analysis, age [odds ratio (OR) = 1.030, 95% CI:1.000 ~ 1.050, P = 0.049], ACB score (OR = 1.150, 95% CI:1.020 ~ 1.290, P = 0.025), polypharmacy (OR = 2.140, 95% CI:1.190 ~ 3.870, P = 0.012), but not Charlson Comorbidity Index (OR = 0.920, 95% CI:0.810 ~ 1.040, P = 0.172) were significantly associated with higher falls rate. Of patients admitted with falls, 29.8% had drug‐related orthostatic hypotension, 24.7% had drug‐related bradycardia, 37.3% were prescribed centrally acting drugs, and 12.0% were taking inappropriate hypoglycemic agents. Conclusion Polypharmacy results in cumulative ACB and both are significantly associated with falls risk in older adults. The presence of polypharmacy and each unit rise in ACB score have a stronger effect of increasing falls risk compared to age and comorbidities. Polypharmacy (the use of ≥ 5 regular oral medication) is very common in adults over 65 and its prevalence is increasing. Polypharmacy and its cumulative effect on Acetylcholine Burden (ACB) both are significantly associated with increased falls risk and hospitalisation in older adults ≥ 65 years. The presence of polypharmacy and each unit rise in ACB score have a stronger effect of increasing falls risk compared to age and comorbidities.