Consumption of anticholinergic drugs in elderly people between 65 and 80 years of age consultants in an emergency service
e202307061
Keywords:
Cholinergic antagonists, Anticholinergic burden, Anticholinergic burden scales, Medication consumption, Aged, Ambulatory careAbstract
BACKGROUND // With age increases the consumption of drugs, including anticholinergics. The anticholinergic load is a predictor of falls, cognitive impairment and mortality, and its calculation is useful. The objectives of this paper was to know the prevalence of anticholinergic consumption and anticholinergic load according to different scales, and the variables that influence the prevalence and load.
METHODS // An analytical and cross-sectional study was carried out. The sample was obtained by cluster sampling (95% confidence level, 3% precision) of patients aged sixty-five/eighty consulting an emergency department. Dependent variables were Anticholinergic drugs consumed and anticholinergic load calculated using 10 scales: Anticholinergic Activity Scale (AAS); Anticholinergic Burden Classification (ABC); Anticholinergic Cognitive Burden Scale (ACB); Anticholinergic Drug Scale (ADS); Anticholinergic Load Scale (ALS); Anticholinergic Risk Scale (ARS); Clinician-Rated Anticholinergic Scale (CrAS); Chew’s scale (Chew); Drug Burden Index (DBI); and Duran’s scale (Duran). Independent variables were demographics, chronic pathologies and drugs consumed. Statistical analysis: description of variables and analytical study through a multivariate analysis (regression analysis) to avoid confounding factors.
RESULTS // 456 patients participated, mean consumption was seven drugs (95% CI 6.81-7.59). 75.2% (95% CI 71%-79%) were taking some anticholinergic; mean of anticholinergics of 1.91 (95% CI 1.75%-2.08%). Using the scales simultaneously, 58.1% (95% CI 53.4%-62.5%) had a high anticholinergic load. The scales that detected the highest anticholinergic risk were DBI (50.7%) and ALS (45.8%), and those with the highest, ABC load (19.1%) and DBI (17.3%). Taking anticholinergics was associated in a statistically significant way with suffering nephrourological pathology (adjusted odds ratio (ORa) 2.33, 95% CI 1.15-4.72), and psychiatric (ORa 4.45, 95% CI 1.62-12.22), and higher drug use (ORa 1.50, 95% CI 1.32-1.71). In addition, the high anticholinergic load was associated in a statistically significant way with suffering nephrourological pathology (ORa of 2.66, 95%CI 1.49-4.74), neurological (ORa of 2.52, 95%CI 1.32-4, 79), psychiatric (ORa of 8.15, 95%CI 3.71-17.90) and was also associated with consuming more drugs (ORa of 1.37, 95%CI 1.25-1.50).
CONCLUSIONS // A high number of anticholinergics are consumed, associating this with suffering from renourological and psychiatric pathologies and with a greater consumption of medications. There is great variability between anticholinergic load scales. Its joint use improves the detection of consumption and anticholinergic load.
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