Impact of Multiple Prescriptions With Anticholinergic Properties on Adverse Clinical Outcomes in the Elderly: A Longitudinal Cohort Study in Taiwan

Wen Han Hsu, Shih Tsung Huang, Wan Hsuan Lu, Yu Wen Wen, Liang Kung Chen, Fei Yuan Hsiao*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)966-974
Number of pages9
JournalClinical Pharmacology and Therapeutics
Volume110
Issue number4
DOIs
StatePublished - Oct 2021

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