Andrea Corsonello1, Annalisa Cozza2, Sonia D'Alia2, Graziano Onder3, Stefano Volpato4, Carmelinda Ruggiero5, Antonio Cherubini6, Mirko Di Rosa2, Paolo Fabbietti2, Fabrizia Lattanzio7. 1. Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy. Electronic address: a.corsonello@inrca.it. 2. Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy. 3. Department of Gerontology, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Gemelli University Hospital, Rome, Italy. 4. Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy. 5. Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy. 6. Geriatria, Accettazione geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, Ancona, Italy. 7. Scientific Direction, IRCCS INRCA, Ancona, Italy.
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.
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 depressedpatients 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.
Authors: Patricia Amoros-Reboredo; Dolors Soy; Marta Hernandez-Hernandez; Sabela Lens; Conxita Mestres Journal: Int J Environ Res Public Health Date: 2020-05-26 Impact factor: 3.390