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Nouri M, Salimi S, Kosha M, Abtahi D. Evaluation of the Effect of Aripiprazole Supplementation in the Prevention of Delirium in Patients Admitted to the General Intensive Care Unit. Adv Biomed Res 2023; 12:198. [PMID: 37694242 PMCID: PMC10492625 DOI: 10.4103/abr.abr_314_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/15/2023] [Accepted: 03/18/2023] [Indexed: 09/12/2023] Open
Abstract
Background To prove the position of aripiprazole as a preventive and safe agent in delirium in patients admitted to the intensive care unit (ICU), it is necessary to conduct randomized controlled clinical trials with appropriate design. Materials and Methods In this study, 80 patients were randomly divided into two groups of 40. Group A received placebo mart for one week, and group B received 15 mg aripiprazole daily (dissolved in 10 cc) daily. As a criterion for assessing delirium, the Confusion Assessment methods for the ICU (CAM-ICUs) were evaluated daily for patients. At the end of the study, the trends of CAM-ICU and CAM-ICU changes on day 7 were compared between the two groups. All statistical tests were performed in two domains with a significance level of 5% using the t-test. Statistical Package for the Social Sciences (SPSS) 21 software was used to analyze the data. Results The use of aripiprazole in the studied indices was not statistically significant (P > 0.05). The results related to the length of stay in the ICU, showed that although the use of aripiprazole has reduced the length of hospitalization of patients in the ICU, this rate of reduction, was not significant (P > 0.05). Conclusion The use of aripiprazole with the approach of reducing the risk or controlling the occurrence of delirium on patients admitted to the intensive care unit, despite creating some beneficial effects such as reducing the length of hospital stay in the ICU, cannot be clearly and significantly effective.
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Affiliation(s)
- Mehranoosh Nouri
- Department of Anesthesiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Salimi
- Department of Anesthesiology, School of Medicine, Anesthesiology Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Kosha
- Department of Neurosurgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dariush Abtahi
- Department of Anesthesiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Elsorady KE, El-Mohsen MA. Association between potentially inappropriate prescribing, polypharmacy, and functional/cognitive impairment among Egyptian geriatric patients. JOURNAL OF GERONTOLOGY AND GERIATRICS 2023:1-11. [DOI: 10.36150/2499-6564-n585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Elsorady KE, Matter LM, Abdelrahim DS. Potentially Inappropriate Prescriptions and Hospital Outcome among Geriatric Patients. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Oudewortel L, van der Roest HG, Onder G, Wijnen VJM, Liperoti R, Denkinger M, Finne-Soveri H, Topinková E, Henrard JC, van Gool WA. The Association of Anticholinergic Drugs and Delirium in Nursing Home Patients With Dementia: Results From the SHELTER Study. J Am Med Dir Assoc 2021; 22:2087-2092. [PMID: 34197793 DOI: 10.1016/j.jamda.2021.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/12/2021] [Accepted: 05/29/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Drugs with anticholinergic properties are associated with an increased prevalence of delirium, especially in older persons. The aim of this study was to evaluate the association between the use of this class of drugs in nursing home (NH) patients and prevalence of delirium, particularly in people with dementia. DESIGN Cross-sectional multicenter study. SETTING AND PARTICIPANTS 3924 nursing home patients of 57 nursing homes in 7 European countries participating in the Services and Health for Elderly in Long TERmcare (SHELTER) project. METHODS Descriptive statistics, calculation of percentage, and multivariable logistic analysis were applied to describe the relationship between anticholinergic drug use and prevalence of delirium in NH patients. The Anticholinergic Risk Scale (ARS) and the Anticholinergic Burden Scale (ACB) were used to calculate the anticholinergic load. RESULTS 54% of patients with dementia and 60% without dementia received at least 1 anticholinergic drug according to the ACB. The prevalence of delirium was higher in the dementia group (21%) compared with the nondementia group (11%). Overall, anticholinergic burden according to the ACB and ARS was associated with delirium both in patients with and without dementia, with odds ratios ranging from 1.07 [95% confidence interval (CI) 0.94-1.21] to 1.26 (95% CI 1.11-1.44). These associations reached statistical significance only in the group of patients with dementia. Among patients with dementia, delirium prevalence increased only modestly with increasing anticholinergic burden according to the ACB, from 20% (with none or minimal anticholinergic burden) to 25% (with moderate burden) and 27% delirium (with strong burden scores). CONCLUSIONS AND IMPLICATIONS The ACB scale is relatively capable to detect anticholinergic side effects, which are positively associated with prevalence of delirium in NH patients. Given the modest nature of this association, strong recommendations are currently not warranted, and more longitudinal studies are needed.
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Affiliation(s)
- Letty Oudewortel
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Henriëtte G van der Roest
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, the Netherlands
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Viona J M Wijnen
- Psychogeriatric Observation Unit, Institution for Mental Health Care, Parnassia Groep, the Netherlands
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michael Denkinger
- Agaplesion Bethesda Clinic, Geriatric Centre Ulm/Alb-Donau, Ulm University, Ulm, Germany
| | - Harriet Finne-Soveri
- Department of Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | - Eva Topinková
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Jean-Claude Henrard
- Research Unit Health-Environment-Ageing, Versailles-Saint-Quentin en Yvelines University, Paris, France
| | - Willem A van Gool
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Fatehi Hassanabad A, Bahrami N, Novick RJ, Ali IS. Delirium and depression in cardiac surgery: A comprehensive review of risk factors, pathophysiology, and management. J Card Surg 2021; 36:2876-2889. [PMID: 34120376 DOI: 10.1111/jocs.15610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mental health and wellbeing continue to gain more attention as they are inextricably associated with clinical outcomes, particularly quality of life. Many medical ailments and major surgeries affect patients' mental health, including depression and delirium. AIMS The objective of this manuscript was to comprehensively review and critically examine the literature pertaining to cardiac surgery, depression, and delirium. METHODS This is a narrative review article. We performed our search analysis by using the following key words: "Cardiac Surgery", "Depression", "Delirium", "Clinical outcomes", and "Mental Health". Search analysis was done on MedLine PubMed, accessing indexed peer-reviewed publications. RESULTS Cardiac Surgery is a life-altering intervention indicated to improve morbidity and mortality in patients with cardiovascular diseases. Psychiatric conditions before and after cardiac surgery worsen patient prognosis and increase mortality rate. Specifically, preoperative depression increases postoperative depression and is associated with impaired functional status, slow physical recovery, and an increased readmission rate. DISCUSSION Although the exact pathophysiology between depression and cardiovascular disease (CVD) is unknown, several pathways have been implicated. Unmanaged depression can also lead to other psychological conditions such as delirium. Like depression, the exact association between delirium and CVD is not well understood, but believed to be multifactorial. CONCLUSION Herein, we provide a comprehensive review of the links between depression, delirium, and cardiovascular surgery. We critically examine the current data that pertains to the pathophysiology of these debilitating mental health issues in the context of cardiac surgery. Finally, we summarize the various treatment options available for managing depression and delirium in the cardiac surgery patient population.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Nabila Bahrami
- Department of Medicine, Department of Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Richard J Novick
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Imtiaz S Ali
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
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Rawle MJ, McCue L, Sampson EL, Davis D, Vickerstaff V. Anticholinergic Burden Does Not Influence Delirium Subtype or the Delirium-Mortality Association in Hospitalized Older Adults: Results from a Prospective Cohort Study. Drugs Aging 2021; 38:233-242. [PMID: 33415708 PMCID: PMC7914229 DOI: 10.1007/s40266-020-00827-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anticholinergic burden (ACB) is associated with an increased risk of delirium in the older population outside of the acute hospital setting. In acute settings, delirium is associated with increased mortality, and this association is greater with full syndromal delirium (FSD) than with subsyndromal delirium (SSD). Little is known about the impact of ACB on delirium prevalence or subtype in hospitalized older adults or the impact on mortality in this population. OBJECTIVES Our objectives were to determine whether ACB moderates associations between the subtype of delirium experienced by hospitalized older adults and to explore factors (including ACB) that might moderate consequent associations between delirium and mortality in hospital inpatients. METHODS We conducted a retrospective analysis of a cohort of 784 older adults with unplanned admission to a North London acute medical unit between June and December 2007. Univariate regression analyses were performed to explore associations between ACB, as represented by the Anticholinergic Burden Scale (ACBS), delirium subtype (FSD vs. SSD), and mortality. RESULTS The mean age of the sample was 83 ± standard deviation (SD) 7.4 years, and the majority of patients were female (59%), lived in their own homes (71%), were without dementia (75%), and died between hospital admission and the end of the 2-year follow-up period (59%). Mean length of admission was 13.2 ± 14.4 days. Prescription data revealed an ACBS score of 1 in 26% of the cohort, of 2 in 12%, and of ≥ 3 in 16%. The mean total ACBS score for the cohort was 1.1 ± 1.4 (range 0-9). Patients with high ACB on admission were more likely to have severe dementia, to have multiple comorbidities, and to live in residential care. Higher ACB was not associated with delirium of either subtype in hospitalized older adults. Delirium itself was associated with increased mortality, and greater associations were seen in FSD (hazard ratio [HR] 2.27; 95% confidence interval [CI] 1.70-3.01) than in SSD (HR 1.58; 95% CI 1.2-2.09); however, ACB had no impact on this relationship. CONCLUSIONS ACB was not found to be associated with increased delirium of either subtype or to have a demonstrable impact on mortality in delirium. Prior suggestions of links between ACB and mortality in similar populations may be mediated by higher levels of functional dependence, greater levels of residential home residence, or an increased prevalence of dementia in this population.
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Affiliation(s)
- Mark James Rawle
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
- Whipps Cross University Hospital, London, UK
| | - Laura McCue
- Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research Department, UCL, London, UK
- Barnet, Enfield and Haringey Mental Health Trust, London, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, UCL, London, UK
- Research Department of Primary Care and Population Health, UCL, London, UK
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Potentially Inappropriate Medications, Drug-Drug Interactions, and Anticholinergic Burden in Elderly Hospitalized Patients: Does an Association Exist with Post-Discharge Health Outcomes? Drugs Aging 2020; 37:585-593. [PMID: 32445121 DOI: 10.1007/s40266-020-00767-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Polypharmacy is very common in elderly patients and is associated with detrimental outcomes. OBJECTIVE Our objective was to evaluate the associations between a large panel of therapy quality indicators, including explicit lists of potentially inappropriate medications (PIMs; Beers criteria and Screening Tool of Older Persons' potentially inappropriate Prescriptions [STOPP] criteria), the Anticholinergic Cognitive Burden (ACB) score, and the number of drug-drug interactions (DDIs), with respect to mortality, rehospitalization, and physical function decline within 3 months from hospital discharge in a cohort of hospitalized elderly patients. METHODS We studied 2631 individuals aged ≥ 65 years (median age 79.6; males 48.6%) enrolled in the REPOSI registry. The relationships with mortality and rehospitalization were evaluated using Cox regressions, and relationships with functional status change (as percentage variation of Barthel Index [BI]) were evaluated using mixed linear models. RESULTS None of the studied indicators was associated with mortality and rehospitalization. Conversely, only ACB was associated with physical function decline, even after correction for confounders (adjusted mean BI variation of - 7.55%; 95% confidence interval [CI] - 12.37 to - 2.47). The number of medications at discharge, particularly polypharmacy (more than five drugs daily), were the only therapy-related factors associated with mortality (adjusted hazard ratio [aHR] 1.05 [95% CI 1.01-1.10] and 1.70 [95% CI 1.12-2.58], respectively) and rehospitalization (aHR 1.05 [95% CI 1.01-1.08] and 1.31 [95% CI 1.01-1.71], respectively). CONCLUSION Polypharmacy, a very simple measure, outperformed sophisticated PIM and DDI indicators of quality of therapy as a correlate of primary clinical outcomes, whereas ACB was associated with physical function decline. Thus, innovative approaches to the definition and research of PIMs and DDIs are eagerly awaited from the perspective of averaging the quantitative burden and qualitative interaction of drugs.
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D'Alia S, Guarasci F, Bartucci L, Caloiero R, Guerrieri ML, Soraci L, Colombo D, Crescibene L, Onder G, Volpato S, Cherubini A, Ruggiero C, Corsonello A, Lattanzio F, Fabbietti P. Hand Grip Strength May Affect the Association Between Anticholinergic Burden and Mortality Among Older Patients Discharged from Hospital. Drugs Aging 2020; 37:447-455. [PMID: 32415534 DOI: 10.1007/s40266-020-00766-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The relationship between anticholinergic burden and mortality is unclear, and the impact of anticholinergic burden on prognosis may vary in the presence of other conditions common in old age. We aimed to investigate the role of hand grip strength as a potential effect modifier in the association between anticholinergic burden and 1-year mortality in older patients discharged from hospital. METHODS Our series consisted of 620 older patients consecutively admitted to seven geriatric and internal medicine acute care wards in the context of a prospective multicenter observational study. Overall anticholinergic burden was assessed by Anticholinergic Cognitive Burden (ACB) score. Hand grip strength was assessed by the use of a North Coast medical hand dynamometer and categorized by using sex-specific cut-offs (women < 15 kg, men < 20 kg). The study outcome was 1-year mortality. Statistical analysis was performed by Cox regression analysis. RESULTS After adjusting for potential confounders, the co-occurrence of an ACB score of 2 or more and low hand grip strength was significantly associated with mortality (hazard ratio [HR] = 2.30, 95% confidence interval [CI] 1.07-6.01). Stratified analysis confirmed that an ACB score of 2 or more was associated with mortality among patients with low (HR = 2.15, 95% CI 1.08-5.02), but not normal hand grip strength (HR = 0.88, 95% CI 0.13-3.52). The association was confirmed among patients with low hand grip strength after adjusting for the ACB score at the 3-month follow-up (HR = 2.20; 95% CI 1.09-4.87), as well as when considering the ACB score as a continuous variable (HR = 1.24, 95% CI 1.03-1.48). CONCLUSIONS The ACB score at discharge may predict mortality among older patients discharged from an acute care hospital with low hand grip strength. Hospital physicians should be aware that prescribing anticholinergic medications in such a vulnerable population may have negative prognostic implications.
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Affiliation(s)
- Sonia D'Alia
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy
| | - Francesco Guarasci
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy.
| | - Luca Bartucci
- Unit of Geriatric Medicine, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy
| | - Ramona Caloiero
- Unit of Geriatric Medicine, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy
| | - Maurizio Leonardo Guerrieri
- Unit of Geriatric Medicine, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy
| | - Luca Soraci
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Daniele Colombo
- Unit of Rehabilitative Pneumology, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Casatenovo, Italy
| | - Lucia Crescibene
- Clinical Laboratory, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
| | - Graziano Onder
- Department of Cardiovascular and Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Carmelinda Ruggiero
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy.,Unit of Geriatric Medicine, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy
| | - Fabrizia Lattanzio
- Scientific Direction, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy
| | - Paolo Fabbietti
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy
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Association between anticholinergic drug burden and mortality in older people: a systematic review. Eur J Clin Pharmacol 2019; 76:319-335. [PMID: 31832732 DOI: 10.1007/s00228-019-02795-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/05/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE The purpose of the study is to conduct a systematic review of studies examining the association between anticholinergic burden and mortality in older individuals. METHODS A literature search was performed to identify relevant studies, using MEDLINE, EMBASE, PsycINFO and CENTRAL, from January 1990 to December 2018. We included studies of patients with a mean age of 65 years or older where the anticholinergic burden was estimated using anticholinergic risk assessment tools, and associations between anticholinergic load and mortality were investigated. The primary outcome of interest was the association between anticholinergic burden and mortality. RESULTS Twenty-seven studies were included. These were three cross-sectional, one nested case-control and 23 prospective or retrospective cohort studies. Most studies were determined to be of good quality. A total of 15 studies reported a positive correlation between anticholinergic burden and mortality, while the remaining 10 studies did not report a significant association. Eighteen out of 27 studies (80%) had a short follow-up period of 1 year or less. Among the five high-quality studies that met all the domains of the quality assessment criteria, four showed a positive association. CONCLUSION The variation in results could relate to the quality of the studies, follow-up period, anticholinergic risk assessment tool used and the study setting. Sixty-three percent (n = 17) of all the included studies, but almost all of the high-quality studies with an extended follow-up, reported a positive correlation between anticholinergic burden and mortality. Further high-quality research, using standardized measures and with adequate follow-up periods, is required to confirm the relationship between anticholinergic burden and mortality.
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Aalto UL, Finne-Soveri H, Kautiainen H, Roitto HM, Öhman H, Pitkälä KH. Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities. J Am Med Dir Assoc 2019; 20:1156-1162. [PMID: 30910551 DOI: 10.1016/j.jamda.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/28/2019] [Accepted: 02/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare 3 internationally established criteria for drugs with anticholinergic properties (DAPs) and their associated factors in long-term care facilities, and to investigate the association between use of DAPs and psychological well-being (PWB) or mortality. DESIGN Cross-sectional study and 1-year follow-up of all-cause mortality. SETTING AND PARTICIPANTS Of all 4449 residents living in long-term care facilities in Helsinki in 2011, 2432 (≥65 years of age) participated after exclusion of residents with severe dementia. MEASUREMENTS Data on demographics, medication use, and active diagnoses were collected by trained staff using structured questionnaires. DAP use was defined by the following 3 international criteria: Chew's list, the Anticholinergic Risk Scale, and the Anticholinergic Drug Scale. The total number of DAPs was counted and referred to as anticholinergic burden. PWB was assessed by a questionnaire and yielded a score ranging from 0 to 1. Mortality data was retrieved from central registers. RESULTS Of all participants, 85% were DAP users according to at least 1 of the 3 criteria used. Overlap between the 3 criteria was only moderate. DAP users were younger and a larger proportion of them had better cognition. However, they suffered more often from depression and other psychiatric diagnoses than nonusers. DAP users had lower PWB scores than those not using DAPs, and PWB decreased linearly in the overlapping groups from nonusers to those using DAPs according to all 3 criteria. The total number of DAPs used predicted mortality. CONCLUSIONS AND IMPLICATIONS DAP use and PWB appear to be negatively associated. When combining several criteria of DAPs, their burden predicted mortality. Clinicians should carefully consider the potential benefits and harms when prescribing DAPs to older persons.
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Affiliation(s)
- Ulla L Aalto
- Department of General Practice, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland.
| | - Harriet Finne-Soveri
- Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Hannu Kautiainen
- Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Hanna-Maria Roitto
- Department of General Practice, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland
| | - Hannareeta Öhman
- Department of General Practice, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki, Finland; Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
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Gamble DT, Clark AB, Luben RN, Wareham NJ, Khaw KT, Myint PK. Baseline anticholinergic burden from medications predicts incident fatal and non-fatal stroke in the EPIC-Norfolk general population. Int J Epidemiol 2019; 47:625-633. [PMID: 29452356 DOI: 10.1093/ije/dyx265] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 11/14/2022] Open
Abstract
Background Stroke is primarily a disease of older age, with a substantial impact on global mortality and morbidity. Medications with anticholinergic effects are widely used, but no studies have been conducted to examine the relationship between anticholinergic burden (ACB) and stroke in a general population. Method The sample was drawn from the EPIC-Norfolk cohort. Baseline assessments were carried out during 1993-97 and participants were followed up until March 2016. Participants were divided into four groups according to their total ACB score at baseline; these groups were those with a total ACB score of 0, 1, 2-3 and >3. After exclusion, Cox proportional hazards models were constructed to determine the associations between the ACB score groups and the risk of incident stroke and stroke mortality. Sensitivity analysis and propensity score matched analyses were performed. Results In total 25 639 participants attended the first health check; 3917 participants were excluded, leaving 21 722 participants to be included. Participants had a mean age [standard deviation (SD)] of 58.9 (9.2) years (54.4% women). Of these, 2131 suffered incident stroke and 562 died from stroke. Mean follow-up was approximately 18 years for both outcomes. In the fully adjusted model, those with an ACB of >3 had 59% relative risk of incident stroke {hazard ratio [HR] [95% confidence interval (CI) 1.59 [1.34-1.89]} and 86% relative risk of stroke mortality [1.86 (1.37-2.53)] compared with those in ACB 0 category. Sensitivity analyses and propensity score matched analyses showed similar results. Conclusions Our results provide an incentive for the cautious use of medications with anticholinergic properties, to help reduce the global burden of stroke.
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Affiliation(s)
- David T Gamble
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Robert N Luben
- Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Kay-Tee Khaw
- Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Phyo K Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Corsonello A, Cozza A, D'Alia S, Onder G, Volpato S, Ruggiero C, Cherubini A, Di Rosa M, Fabbietti P, Lattanzio F. The excess mortality risk associated with anticholinergic burden among older patients discharged from acute care hospital with depressive symptoms. Eur J Intern Med 2019; 61:69-74. [PMID: 30449478 DOI: 10.1016/j.ejim.2018.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/03/2018] [Accepted: 11/10/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The relationship between anticholinergic burden and mortality is controversial, and the impact of anticholinergic burden on prognosis may vary in presence of other conditions common in old age. We aimed at investigating the role of depressive symptoms as potential effect modifiers in the association between anticholinergic burden and 1-year mortality in older patients discharged from hospital. METHODS Our series consisted of 576 older patients consecutively admitted to seven geriatric and internal medicine acute care wards in the context of a prospective multicenter observational study. Overall anticholinergic burden was assessed by Anticholinergic Cognitive Burden (ACB) score. Depressive symptoms were assessed by 15-item Geriatric Depression Scale (GDS). The study outcome was all-cause mortality during 12-months follow-up. Statistical analysis was carried out by Cox regression analysis. RESULTS After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with GDS > 5 (HR = 3.70; 95%CI = 1.18-11.6), but not among those with GDS ≤ 5 (HR = 2.32; 95%CI = 0.90-6.24). The association was confirmed among depressed patients after adjusting for ACB score at 3-month follow-up (HR = 3.58; 95%CI = 1.21-10.7), as well as when considering ACB score as a continuous variable (HR = 1.42; 95%CI = 1.10-1.91). The interaction between ACB score at discharge and BADL dependency was statistically significant (p < .005). CONCLUSIONS ACB score at discharge may predict mortality among older patients discharged from acute care hospital carrying high GDS score e. Hospital physician should be aware that prescribing anticholinergic medications in such a vulnerable population may have negative prognostic implications.
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Affiliation(s)
- Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy.
| | - Annalisa Cozza
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy
| | - Sonia D'Alia
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy
| | - Graziano Onder
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Gemelli University Hospital, Rome, Italy
| | - Stefano Volpato
- Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Carmelinda Ruggiero
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy
| | - Paolo Fabbietti
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy
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Ah Y, Suh Y, Jun K, Hwang S, Lee J. Effect of anticholinergic burden on treatment modification, delirium and mortality in newly diagnosed dementia patients starting a cholinesterase inhibitor: A population‐based study. Basic Clin Pharmacol Toxicol 2019; 124:741-748. [DOI: 10.1111/bcpt.13184] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/28/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Young‐Mi Ah
- College of Pharmacy Yeungnam University Gyeongsangbuk‐do Korea
| | - Yewon Suh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences Seoul National University Seoul Korea
| | - Kwanghee Jun
- College of Pharmacy and Research Institute of Pharmaceutical Sciences Seoul National University Seoul Korea
| | - Sunghee Hwang
- College of Pharmacy and Institute of Pharmaceutical Science and Technology Hanyang University Ansan Korea
| | - Ju‐Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences Seoul National University Seoul Korea
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Tan EC, Eriksdotter M, Garcia-Ptacek S, Fastbom J, Johnell K. Anticholinergic Burden and Risk of Stroke and Death in People with Different Types of Dementia. J Alzheimers Dis 2018; 65:589-596. [DOI: 10.3233/jad-180353] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Edwin C.K. Tan
- Centre for Medicine Use and Safety, Monash University, Parkville, Australia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, SwedenSweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Internal Medicine, Section for Neurology, Södersjukhuset, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, SwedenSweden
| | - Kristina Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, SwedenSweden
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Yoshida M, Kato D, Nishimura T, Van Schyndle J, Uno S, Kimura T. Anticholinergic burden in the Japanese elderly population: Use of antimuscarinic medications for overactive bladder patients. Int J Urol 2018; 25:855-862. [DOI: 10.1111/iju.13758] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Masaki Yoshida
- Department of Urology; National Center for Geriatrics and Gerontology; Obu Japan
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Lattanzio F, Onder G, La Fauci MM, Volpato S, Cherubini A, Fabbietti P, Ruggiero C, Garasto S, Cozza A, Crescibene L, Tarsitano A, Corsonello A. Anticholinergic Burden is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital. J Am Med Dir Assoc 2018; 19:942-947. [PMID: 30049542 DOI: 10.1016/j.jamda.2018.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine whether anticholinergic burden may predict differently 1-year mortality in older patients discharged from acute care hospitals with or without dependency in basic activities of daily living (BADL). DESIGN Prospective observational study. SETTING AND PARTICIPANTS Our series consisted of 807 patients aged 65 years or older consecutively discharged from 7 acute care geriatric wards throughout Italy between June 2010 and May 2011. MEASURES Overall anticholinergic burden was assessed by the anticholinergic cognitive burden (ACB) score. Dependency was rated by BADL, and dependency in at least 1 BADL was considered as a potential mediator in the analysis. The study outcome was all-cause mortality during 12-months of follow-up. RESULTS Patients included in the study were aged 81.0 ± 7.4 years, and 438 (54.3%) were female. During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with dependency in at least 1 BADL [hazard ratio (HR) 2.25 95% confidence (CI) 1.22‒4.14], but not among independent ones (HR 1.06 95% CI 0.50‒2.34). The association was confirmed among dependent patients after adjusting for the number of lost BADL at discharge (HR 2.20 95% CI 1.18‒4.04) or ACB score at 3-month follow-up (HR 2.18 95% CI 1.20‒3.98), as well as when considering ACB score as a continuous variable (HR 1.28 95% CI 1.11‒1.49). The interaction between ACB score at discharge and BADL dependency was highly significant (P < .001). CONCLUSIONS/IMPLICATIONS ACB score at discharge may predict mortality among older patients discharged from an acute care hospital carrying at least 1 BADL dependency. Hospital physicians should be aware that prescribing anticholinergic medications in this population may have negative prognostic implications and they should try to reduce anticholinergic burden at discharge whenever possible.
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Affiliation(s)
- Fabrizia Lattanzio
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
| | - Graziano Onder
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Gemelli University Hospital, Rome, Italy
| | | | - Stefano Volpato
- Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Antonio Cherubini
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
| | - Paolo Fabbietti
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
| | - Carmelinda Ruggiero
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Sabrina Garasto
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
| | - Annalisa Cozza
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
| | - Lucia Crescibene
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
| | - Assunta Tarsitano
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
| | - Andrea Corsonello
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy.
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Lattanzio F, Corica F, Schepisi R, Amantea D, Bruno F, Cozza A, Onder G, Volpato S, Cherubini A, Ruggiero C, Maggio MG, Corsonello A. Anticholinergic burden and 1-year mortality among older patients discharged from acute care hospital. Geriatr Gerontol Int 2018; 18:705-713. [PMID: 29292589 DOI: 10.1111/ggi.13234] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/13/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022]
Abstract
AIM The association between anticholinergic burden and mortality is controversial. We aimed to investigate whether the anticholinergic cognitive burden (ACB) score predicts 1-year mortality in older patients discharged from acute care hospitals. METHODS Our series consisted of 807 hospitalized patients aged ≥65 years. Patients were followed up for 12 months after discharge. All-cause mortality was the outcome of the study. The ACB score at discharge (0, 1, ≥2) and increasing ACB score from admission to discharge (no increase, +1, +2 or more) were calculated and used as exposure variables. Cox proportional hazards models adjusted for potential confounders were used for the analysis. Interactions between the ACB score and cognitive impairment or history of falls were also investigated. RESULTS During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting for potential confounders, a discharge ACB score of ≥2 (HR 1.69, 95% CI 1.09-2.65) was significantly associated with the outcome, whereas the association between increasing ACB score of +2 or more and mortality was weaker (HR 1.30, 95% CI 0.95-1.92). The interaction between the ACB score at discharge or increasing ACB score and cognitive impairment was statistically significant (P = 0.003 and P = 0.004, respectively), whereas that between the ACB score and falls was not. CONCLUSIONS The ACB score at discharge and, to a lesser extent, an increasing ACB score during hospital stay are associated with an increased risk of 1-year mortality in older patients discharged from hospital. Such an association is stronger among patients with cognitive impairment. Geriatr Gerontol Int 2018; 18: 705-713.
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Affiliation(s)
- Fabrizia Lattanzio
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
| | - Francesco Corica
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberto Schepisi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Diana Amantea
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Francesco Bruno
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Annalisa Cozza
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
| | - Graziano Onder
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Gemelli University Hospital, Rome, Italy
| | - Stefano Volpato
- Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Antonio Cherubini
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
| | - Carmelinda Ruggiero
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marcello G Maggio
- Department of Clinical and Experimental Medicine and Geriatric Rehabilitation Department, University of Parma, Parma, Italy
| | - Andrea Corsonello
- Italian National Research Center on Aging (INRCA), Ancona and Cosenza, Italy
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Solimine S, Takeshita J, Goebert D, Lee J, Schultz B, Guerrero M, Tanael M, Pilar M, Fleming L, Kracher S, Lawyer L. Characteristics of Patients With Constant Observers. PSYCHOSOMATICS 2018; 59:67-74. [DOI: 10.1016/j.psym.2017.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 01/24/2023]
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Gutiérrez-Valencia M, Martínez-Velilla N, Vetrano DL, Corsonello A, Lattanzio F, Ladrón-Arana S, Onder G. Anticholinergic burden and health outcomes among older adults discharged from hospital: results from the CRIME study. Eur J Clin Pharmacol 2017; 73:1467-1474. [DOI: 10.1007/s00228-017-2312-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
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20
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Chatterjee S, Bali V, Carnahan RM, Chen H, Johnson ML, Aparasu RR. Risk of Mortality Associated with Anticholinergic Use in Elderly Nursing Home Residents with Depression. Drugs Aging 2017; 34:691-700. [DOI: 10.1007/s40266-017-0475-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Moorey HC, Zaidman S, Jackson TA. Delirium is not associated with anticholinergic burden or polypharmacy in older patients on admission to an acute hospital: an observational case control study. BMC Geriatr 2016; 16:162. [PMID: 27655289 PMCID: PMC5031270 DOI: 10.1186/s12877-016-0336-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/13/2016] [Indexed: 11/26/2022] Open
Abstract
Background Older people are commonly prescribed multiple medications, including medications with anticholinergic effects. Polypharmacy and anticholinergic medications may be risk factors for the development of delirium. Methods Patients from a medical admission unit who were over 70, with DSM-IV diagnosed delirium and patients without delirium, were investigated. Number of drugs prescribed on admission and anticholinergic burden using two scales (the Anticholinergic Cognitive Burden Scale [ACB] and the Anticholinergic Drug Scale [ADS]) were recorded from electronic prescribing records. The relationship and predictive ability of these were explored. Results The sample included 125 patients with DSM-IV diagnosed delirium and 122 patients without delirium. The mean age of the sample was 84.0 years. The median number of drugs prescribed was 7: 79.8 % were prescribed ≥5 drugs and 29.0 % ≥10 drugs. The median ACB score was 1 and the median ADS score was 1.5. 73.4 % of patients had an ACB score of ≥1 and 73.0 % had a ADS score ≥1. There was no association between: number of drugs prescribed, rate of polypharmacy, rate of excessive polypharmacy, ACB score and ADS score, and a diagnosis of delirium on admission. Only acetylcholinesterase inhibitor use predicted delirium (OR 3.86, p = 0.04) and the number of drugs prescribed was negatively correlated with age (spearman rho = −0.18, p = 0.006). Conclusion Neither number of drugs prescribed, polypharmacy or anticholinergic burden were associated with delirium on admission, questioning the clinical usefulness of anticholinergic drug scales. Further research is needed to unpick fully the relationship between, drugs, anticholinergic burden, age, and prevalent delirium in older patients and whether there is any role for these scales in clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0336-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannah C Moorey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sebastian Zaidman
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. .,Department of Geritric Medicine, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK.
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Abstract
As the population ages, nurses in various clinical settings must identify high-risk groups that are vulnerable to delirium and dementia. They also must be able to provide psychosocial and pharmacologic interventions that promote comfort and safety for patients and their families experiencing these distressful medical conditions. Efforts to facilitate health resolution and restore the patient and caregivers to an optimal level of functioning must be priorities.
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Affiliation(s)
- Carolyn Seeganna
- US Department of Veterans Affairs, Mat-Su Community Based Outpatient Clinic, 865 North Seward Meridian Parkway, Wasilla, AK 99654, USA.
| | - Deborah Antai-Otong
- Department of Veterans Affairs, Veterans Integrated Service Networks-(VISN-17), 2301 E. Lamar Boulevard, Arlington, TX 76006, USA
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Collamati A, Martone AM, Poscia A, Brandi V, Celi M, Marzetti E, Cherubini A, Landi F. Anticholinergic drugs and negative outcomes in the older population: from biological plausibility to clinical evidence. Aging Clin Exp Res 2016; 28:25-35. [PMID: 25930085 DOI: 10.1007/s40520-015-0359-7] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/01/2015] [Indexed: 11/29/2022]
Abstract
The use of medication with anticholinergic properties is widespread among older subjects. Many drugs of common use such as antispasmodics, bronchodilators, antiarrhythmics, antihistamines, anti-hypertensive drugs, antiparkinson agents, skeletal muscle relaxants, and psychotropic drugs have been demonstrated to have an anticholinergic activity. The most frequent adverse effects are dry mouth, nausea, vomiting, constipation, abdominal pain, urinary retention, blurred vision, tachycardia and neurologic impairment such as confusion, agitation and coma. A growing evidence from experimental studies and clinical observations suggests that drugs with anticholinergic properties can cause physical and mental impairment in the elderly population. However, the morbidity and management issues associated with unwanted anticholinergic activity are underestimated and frequently overlooked. Moreover, their possible relation with specific negative outcome in the elderly population is still not firmly established. The aim of the present review was to evaluate the relationship between the use of drugs with anticholinergic activity and negative outcomes in older persons. We searched PubMed and Cochrane combining the search terms "anticholinergic", "delirium", "cognitive impairment", "falls", "mortality" and "discontinuation". Medicines with anticholinergic properties may increase the risks of functional and cognitive decline, morbidity, institutionalization and mortality in older people. However, such evidences are still not conclusive probably due to possible confounding factors. In particular, more studies are needed to investigate the effects of discontinuation of drug with anticholinergic properties. Overall, minimizing anticholinergic burden should always be encouraged in clinical practice to improve short-term memory, confusion and delirium, quality of life and daily functioning.
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Affiliation(s)
- Agnese Collamati
- Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy
| | - Anna Maria Martone
- Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Poscia
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Vincenzo Brandi
- Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy
| | - Michela Celi
- Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy
| | - Emanuele Marzetti
- Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy
| | | | - Francesco Landi
- Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy.
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Burden of Potentially Harmful Medications and the Association With Quality of Life and Mortality Among Institutionalized Older People. J Am Med Dir Assoc 2016; 17:276.e9-14. [PMID: 26805751 DOI: 10.1016/j.jamda.2015.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study investigated the overlap among 3 different definitions of potentially harmful medication (PHM) use and the corresponding associations with resident quality of life and mortality. DESIGN Cross-sectional study with 3-year follow-up for mortality. SETTING Assisted living facilities and nursing homes in Helsinki and Kouvola, Finland. PARTICIPANTS A total of 326 residents. MEASUREMENTS PHM use was defined as (1) use of medications with anticholinergic properties, (2) use of Beers Criteria medications, and (3) concomitant use 3 or more psychotropic medications. Health-related quality of life (HRQoL) was assessed using the 15D and psychological well-being (PWB) scale. Residents self-rated their own health using a 4-point scale. Mortality data were obtained from central registers. RESULTS There were 38.0%, 28.2%, and 12.6% of residents who used PHMs according to 1 (G1), 2 (G2), and 3 definitions (G3), respectively. Overall, 21.2% of residents did not use PHMs according to any of the 3 definitions (G0). There were no significant differences in comorbidity, cognition, or functioning among groups. In adjusted analyses, there was a stepwise association between use of multiple PHMs and poorer self-rated health, poorer PWB, and poorer HRQoL. There was no association in adjusted analyses between PHM use and 3-year mortality (47.8%-63.8%). CONCLUSION PHM use is highly prevalent in institutional settings, regardless of the definition of inappropriateness. Residents who used multiple categories of PHMs were at greatest risk of poor HRQoL, poor PWB, and poor self-rated health. However, there was no apparent association with increased mortality. Given the importance of quality of life as an outcome to older people, further efforts are needed to minimize PHM use in this setting.
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Salahudeen MS, Nishtala PS, Duffull SB. The Influence of Patient Characteristics on Anticholinergic Events in Older People. Dement Geriatr Cogn Dis Extra 2016; 5:530-41. [PMID: 26955385 PMCID: PMC4777954 DOI: 10.1159/000441718] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aims To examine patient characteristics that predict adverse anticholinergic-type events in older people. Methods This retrospective population-level study included 2,248 hospitalised patients. Individual data on medicines that are commonly associated with anticholinergic events (delirium, constipation and urinary retention) were identified. Patient characteristics examined were medicines with anticholinergic effects (ACh burden), age, sex, non-anticholinergic medicines (non-ACM), Charlson comorbidity index scores and ethnicity. The Akaike information criterion was used for model selection. The data were analysed using logistic regression models for anticholinergic events using the software NONMEM. Results ACh burden was found to be a significant independent predictor for developing an anticholinergic event [adjusted odds ratio (aOR): 3.21, 95% CI: 1.23-5.81] for those taking an average of 5 anticholinergic medicines compared to those taking 1. Both non-ACM and age were also independent risk factors (aOR: 1.41, 95% CI: 1.31-1.51 and aOR: 1.08, 95% CI: 1.05-1.10, respectively). Conclusion To our knowledge, this is the first study that has examined population-level data in a nonlinear model framework to predict anticholinergic-type adverse events. This study evaluated the relationship between important patient characteristics and the occurrence of anticholinergic-type events. These findings reinforce the clinical significance of reviewing anticholinergic medicines in older people.
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Lampela P, Paajanen T, Hartikainen S, Huupponen R. Central Anticholinergic Adverse Effects and Their Measurement. Drugs Aging 2015; 32:963-74. [DOI: 10.1007/s40266-015-0321-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ruxton K, Woodman RJ, Mangoni AA. Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis. Br J Clin Pharmacol 2015; 80:209-20. [PMID: 25735839 DOI: 10.1111/bcp.12617] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 12/11/2022] Open
Abstract
AIM The aim was to investigate associations between drugs with anticholinergic effects (DACEs) and cognitive impairment, falls and all-cause mortality in older adults. METHODS A literature search using CINAHL, Cochrane Library, Embase and PubMed databases was conducted for randomized controlled trials, prospective and retrospective cohort and case-control studies examining the use of DACEs in subjects ≥65 years with outcomes on falls, cognitive impairment and all-cause mortality. Retrieved articles were published on or before June 2013. Anticholinergic exposure was investigated using drug class, DACE scoring systems (anticholinergic cognitive burden scale, ACB; anticholinergic drug scale, ADS; anticholinergic risk scale, ARS; anticholinergic component of the drug burden index, DBIAC ) or assessment of individual DACEs. Meta-analyses were performed to pool the results from individual studies. RESULTS Eighteen studies fulfilled the inclusion criteria (total 124 286 participants). Exposure to DACEs as a class was associated with increased odds of cognitive impairment (OR 1.45, 95% CI 1.16, 1.73). Olanzapine and trazodone were associated with increased odds and risk of falls (OR 2.16, 95% CI 1.05, 4.44; RR 1.79, 95% CI 1.60, 1.97, respectively), but amitriptyline, paroxetine and risperidone were not (RR 1.73, 95% CI 0.81, 2.65; RR 1.80, 95% CI 0.81, 2.79; RR 1.39, 95% CI 0.59, 3.26, respectively). A unit increase in the ACB scale was associated with a doubling in odds of all-cause mortality (OR 2.06, 95% CI 1.82, 2.33) but there were no associations with the DBIAC (OR 0.88, 95% CI 0.55, 1.42) or the ARS (OR 3.56, 95% CI 0.29, 43.27). CONCLUSIONS Certain individual DACEs or increased overall DACE exposure may increase the risks of cognitive impairment, falls and all-cause mortality in older adults.
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Affiliation(s)
- Kimberley Ruxton
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, SA, 5042, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, SA, 5042, Australia
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Naja M, Zmudka J, Hannat S, Liabeuf S, Serot JM, Jouanny P. In geriatric patients, delirium symptoms are related to the anticholinergic burden. Geriatr Gerontol Int 2015; 16:424-31. [DOI: 10.1111/ggi.12485] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Moustafa Naja
- Department of Geriatric Medicine; Amiens University Medical Center; Amiens France
- Clinical Research Center; Amiens University Medical Center; Amiens France
| | - Jadwiga Zmudka
- Department of Geriatric Medicine; Amiens University Medical Center; Amiens France
| | - Sanaa Hannat
- Department of Geriatric Medicine; Amiens University Medical Center; Amiens France
| | - Sophie Liabeuf
- Clinical Research Center; Amiens University Medical Center; Amiens France
| | - Jean-Marie Serot
- Department of Geriatric Medicine; Amiens University Medical Center; Amiens France
| | - Pierre Jouanny
- Department of Geriatric Medicine; Amiens University Medical Center; Amiens France
- Department of Geriatric Medicine; Dijon University Medical Center; Dijon France
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Myint PK, Fox C, Kwok CS, Luben RN, Wareham NJ, Khaw KT. Total anticholinergic burden and risk of mortality and cardiovascular disease over 10 years in 21,636 middle-aged and older men and women of EPIC-Norfolk prospective population study. Age Ageing 2015; 44:219-25. [PMID: 25430550 DOI: 10.1093/ageing/afu185] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies have raised concerns that medications with anticholinergic property have potential adverse effects on health outcomes. OBJECTIVES The objective of this study is to examine the prospective relationships between total anticholinergic burden (ACB) from medications and mortality, and cardiovascular disease (CVD) in a general population. DESIGN Observational study. SETTING Community cohort. SUBJECTS We examined data collected from 21,636 men and women without cancer at the baseline who participated in a baseline survey 1993-97 in the European Prospective Investigation into Cancer (EPIC)-Norfolk. They were followed until 2009/11. METHODS We performed Cox-proportional hazards models to determine the associations between total ACB and the subsequent risk of all-cause mortality and incident CVD during the follow-up. RESULTS There were a total of 4,342 people died and 7,328 had an incident CVD during the study follow-up (total person years=322,321 years for mortality and 244,119 years for CVD event). Compared with people with no anticholinergic burden (ACB=0), people with total ACB≥3 from medications had hazards ratios of 1.83 (1.53, 2.20) and 2.17 (1.87, 2.52) for mortality and CVD incidence outcomes, respectively, after adjusting for potential confounders. Repeating the analyses after excluding people with prevalent illnesses, and events occurring within the first 2 years of follow-up, only slightly attenuated the results. CONCLUSION There appear to be a class effect as well as dose-response relationship between the ACB and both outcomes. Future research should focus on understanding the relationship between ACB and mortality, and cardiovascular disease and possibly minimising ACB load where feasible.
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Affiliation(s)
- Phyo Kyaw Myint
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, UK Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire CB2 0QQ, UK
| | - Chris Fox
- School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK
| | - Chun Shing Kwok
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, Lancashire, M13 9WL, UK
| | - Robert N Luben
- Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire CB2 0QQ, UK
| | | | - Kay-Tee Khaw
- Clinical Gerontology Unit, Department of Public Health and Primary Care, Clinical Gerontology Unit, University of Cambridge, Cambridge CB2 2QQ, UK School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
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Inouye SK, Robinson T, Blaum C, Busby-Whitehead J, Boustani M, Chalian A, Deiner S, Fick D, Hutchison L, Johanning J, Katlic M, Kempton J, Kennedy M, Kimchi E, Ko C, Leung J, Mattison M, Mohanty S, Nana A, Needham D, Neufeld K, Richter H. Postoperative Delirium in Older Adults: Best Practice Statement from the American Geriatrics Society. J Am Coll Surg 2015; 220:136-48.e1. [DOI: 10.1016/j.jamcollsurg.2014.10.019] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/24/2014] [Indexed: 12/17/2022]
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Hölttä E, Laurila J, Laakkonen M, Strandberg T, Tilvis R, Pitkala K. Precipitating factors of delirium: Stress response to multiple triggers among patients with and without dementia. Exp Gerontol 2014; 59:42-6. [DOI: 10.1016/j.exger.2014.04.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/22/2014] [Accepted: 04/28/2014] [Indexed: 01/10/2023]
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Anticholinergic Drug Use and Negative Outcomes Among the Frail Elderly Population Living in a Nursing Home. J Am Med Dir Assoc 2014; 15:825-9. [DOI: 10.1016/j.jamda.2014.08.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 11/21/2022]
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Prescripciones inconvenientes en el tratamiento del paciente con deterioro cognitivo. Neurologia 2014; 29:523-32. [DOI: 10.1016/j.nrl.2012.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 05/28/2012] [Indexed: 11/22/2022] Open
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Jannati Y, Bagheri-Nesami M, Sohrabi M, Yazdani-Cherati J, Mazdarani S. Factors associated with post-surgical delirium in patients undergoing open heart surgery. Oman Med J 2014; 29:340-5. [PMID: 25337310 PMCID: PMC4202227 DOI: 10.5001/omj.2014.91] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 08/11/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. METHOD This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression) on SPSS software version 15. RESULTS We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. CONCLUSION Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium.
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Affiliation(s)
- Yadollah Jannati
- Ph.D. in nursing, Assistant Professor of Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Bagheri-Nesami
- Ph.D. in nursing, Assistant Professor of Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Sohrabi
- M.Sc in intensive care nursing, Department of nursing, Ayatollah Rohani Hospital, Babol University of Medical Science, Babol, Iran
| | - Jamshid Yazdani-Cherati
- Ph.D. in Biostatistics, Assistant Professor of Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahrzad Mazdarani
- Psychiatrist, Fatemeh Zahra Heart Center, Mazandaran University of Medical Sciences, Sari, Iran
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Fox C, Smith T, Maidment I, Chan WY, Bua N, Myint PK, Boustani M, Kwok CS, Glover M, Koopmans I, Campbell N. Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review. Age Ageing 2014; 43:604-15. [PMID: 25038833 DOI: 10.1093/ageing/afu096] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes. DESIGN electronic published and unpublished literature/trial registries were systematically reviewed. Studies evaluating medications with anti-cholinergic activity on cognitive function, delirium, physical function or mortality were eligible. RESULTS forty-six studies including 60,944 participants were included. Seventy-seven percent of included studies evaluating cognitive function (n = 33) reported a significant decline in cognitive ability with increasing anti-cholinergic load (P < 0.05). Four of five included studies reported no association with delirium and increasing anti-cholinergic drug load (P > 0.05). Five of the eight included studies reported a decline in physical function in users of anti-cholinergics (P < 0.05). Three of nine studies evaluating mortality reported that the use of drugs with anti-cholinergic properties was associated with a trend towards increased mortality, but this was not statistically significant. The methodological quality of the evidence-base ranged from poor to very good. CONCLUSION medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function, but limited evidence exists for delirium or mortality outcomes.
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Affiliation(s)
- Chris Fox
- School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK
| | - Toby Smith
- School of Rehabilitation Sciences, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Ian Maidment
- Pharmacy, School of Life and Health Sciences, Medicines and Devices in Ageing, Aston Research Centre for Healthy Ageing, (ARCHA), Aston University, Birmingham, UK
| | - Wei-Yee Chan
- School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK
| | - Nelson Bua
- School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK
| | - Phyo Kyaw Myint
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland AB25 2ZD, UK
| | - Malaz Boustani
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chun Shing Kwok
- Norfolk and Norwich University Hospital, Norwich, Norfolk NR4 7UY, UK
| | - Michelle Glover
- School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK
| | - Imogen Koopmans
- School of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK
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Abstract
The International Continence Society (ICS) defines overactive bladder (OAB) as an association of symptoms including "urgency, with or without urge incontinence, usually with increased frequency and nocturia". This conditon has been associated with a decrease in quality of life and a higher related risk of overall health condition decrease, and is rising since its prevalence increases with age and the forecast for the world population estimates an increase of those over 65 years old. Aging alone can be considered a major risk factor for developing OAB symptoms that are considered multifactorial and due to body tissue and anatomic changes, lifestyle-associated factors, comorbidities and personal characteristics. The high prevalence of this condition and multiple etiology factors makes of its treatment a challenge-especially in the older population. A major concern over OAB treatment of elderly patients is the risk of cognitive side effects due to the pharmacologic treatment with anticholinergic drugs. First-line treatment for OAB symptoms are the use of pharmacologic therapy with antimuscarinic drugs, which has been proved to be effective in controlling urgency, urge incontinence episodes, incontinence episodes, and nocturia. The impact caused by this condition is significant regarding the economic and human costs associated bringing into attention the need of studying and reviewing this specific population. Conservative Management and Lifestyle Modifications: Behavioral therapy's aims are to reduce urinary frequency and urgency to an accepted level and to increase bladder outlet volume. It consists of actions to teach patients to improve and learn bladder control. Lifestyle modifications are a conjunct of daily activities that can be managed to have the lowest interference on the functioning of the urinary tract. Pharmacologic Therapy: There are various medications with antimuscarinic properties available for the treatment of OAB symptoms. The most commonly used are oxybutinin, tolterodine, solifenacin, darifenacin, fesosterodine and trospium. Second-line Therapy: OAB treatment accounts for some refractory to conventional treatment patients who will require alternative therapies to achieve improvement of symptoms as the use of intradetrusor injection of botulinum A toxin by binding to receptors on the membrane of cholinergic nerves causing temporary chemodenervation and consequent muscle relaxation. Neuromodulation is also an effective therapy that aims to achieve inhibition of detrusor activity by continuous neural stimulation through peripheral nerves as the use of the tibial nerve or central as it is performed by direct spine stimulation on sacral roots through the implantation of an automated generator. In conclusion, evidence from the literature has shown that antimuscarinic treatment of OAB in the elderly population is safe and effective in improving symptoms and patient's quality of life. Managing OAB symptoms in this population is a great challenge. An optimal therapeutic approach to treat should involve medical treatment with drug and behavioral therapy in addition to lifestyle advice.
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Affiliation(s)
- Ricardo Natalin
- Department of Geriatric Urology, Federal University of Sao Paulo, Rua Napoleão de Barros, 715, 2 andar, São Paulo, Brazil
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Abstract
Delirium in older patients is also associated with persistent functional and cognitive impairment. Nevertheless, it frequently remains unrecognized or misinterpreted by treating physicians and this is particularly true in cases of hypoactive delirium. Screening and assessment instruments are helpful in the identification of patients with delirium. A multifactorial model of a combination of predisposing and precipitating factors best explains the etiology of delirium and avoidance is crucial for its prevention. Whenever delirium is suspected, immediate diagnosis and therapy of the precipitating condition are of primary importance. Non-pharmacological interventions, for example environmental modifications, play an important role in managing behavioral symptoms of delirium. Pharmacological interventions are merely symptomatic and should be limited to patients with severe symptoms when non-pharmacological means fail.
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Affiliation(s)
- K Singler
- Institut für Biomedizin des Alterns, Friedrich-Alexander Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland,
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Hefner G, Laib AK, Sigurdsson H, Hohner M, Hiemke C. The value of drug and metabolite concentration in blood as a biomarker of psychopharmacological therapy. Int Rev Psychiatry 2013; 25:494-508. [PMID: 24151798 DOI: 10.3109/09540261.2013.836475] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Desirable and undesirable effects of a drug are related to its concentration at various sites of actions. For many psychotropic drugs, it has been shown that drug concentration in brain correlates with concentration in blood. The latter is also an available estimate of clearance and bioavailability. Its monitoring enables identification of multiple factors that have an impact on clinical outcomes, especially uncertain compliance and pharmacokinetic peculiarities. For this review we analysed for antidepressants if drug concentration in blood can be used as biomarker for psychopharmacological treatment. Systematic review of the literature revealed for new and old antidepressant drugs that drug and metabolite concentrations in blood are measures of the pharmacokinetic phenotype and related differentially to occupancy of primary target structures, therapeutic effects and unwanted anticholinergic, cardiac and other side effects. Drug concentration in blood can therefore be used as biomarker in clinical practice to guide psychopharmacological treatment with established antidepressant drugs. Monitoring of drug concentration is suitable to improve efficacy and safety of the pharmacotherapy, especially in elderly patients who require complex pharmacological therapies.
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Affiliation(s)
- Gudrun Hefner
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz , Germany
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Abstract
Altered mental status is a common chief compliant among older patients in the emergency department (ED). Acute changes in mental status are more concerning and are usually secondary to delirium, stupor, and coma. Although stupor and coma are easily identifiable, the clinical presentation of delirium can be subtle and is often missed without actively screening for it. For patients with acute changes in mental status the ED evaluation should focus on searching for the underlying etiology. Infection is one of the most common precipitants of delirium, but multiple causes may exist concurrently.
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Affiliation(s)
- Jin H. Han
- Center for Quality Aging, Assistant Professor of Emergency Medicine, Vanderbilt University School of Medicine, Department of Emergency Medicine, 703 Oxford House, Nashville, TN 37232-4700, Phone: 615-936-1434, Fax: 615-936-1316
| | - Scott T. Wilber
- Emergency Medicine Research Center, Associate Professor of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Medical University, 525 East Market Street, Akron, Ohio 44309, Phone: 330-375-7530, Fax: 330-375-7564
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Wagg AS. Antimuscarinic treatment in overactive bladder: special considerations in elderly patients. Drugs Aging 2013; 29:539-48. [PMID: 22715861 DOI: 10.1007/bf03262272] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Overactive bladder is a common condition that increases in prevalence in association with age. Antimuscarinic therapy remains the mainstay of pharmacological treatment for the condition, and there is an increasing body of evidence that supports the use of these drugs. Despite this, and because of concerns about associated adverse effects, older people are less likely to receive active treatment for their condition. This review considers some of the factors that need to be taken into account when using these medications.
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Affiliation(s)
- Adrian S Wagg
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Wagg AS. Antimuscarinic treatment in overactive bladder: special considerations in elderly patients. Drugs Aging 2012. [PMID: 22715861 DOI: 10.2165/11631610-000000000-00000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Overactive bladder is a common condition that increases in prevalence in association with age. Antimuscarinic therapy remains the mainstay of pharmacological treatment for the condition, and there is an increasing body of evidence that supports the use of these drugs. Despite this, and because of concerns about associated adverse effects, older people are less likely to receive active treatment for their condition. This review considers some of the factors that need to be taken into account when using these medications.
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Affiliation(s)
- Adrian S Wagg
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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