Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation.
BACKGROUND
Medications with anticholinergic (antimuscarinic) effects negatively affect physical and cognitive function in community-dwelling older patients. However, it is unknown if anticholinergic drugs exert detrimental effects in older patients undergoing rehabilitation.


OBJECTIVE
The purpose of our study was to assess the effect of anticholinergic drug exposure on functional outcomes in older patients undergoing rehabilitation. We speculated that higher anticholinergic drug exposure would be associated with reduced functional outcomes in this group.


METHODS
Data on clinical characteristics, full medication, anticholinergic drug exposure (total number of anticholinergic drugs [tAD] and Anticholinergic Risk Scale [ARS] score), and Barthel index (BI) score were collected on admission and discharge in a consecutive series of 117 older patients (age 79 [7] years) admitted to the orthopaedic rehabilitation unit of a teaching hospital between July 2010 and March 2011. Outcome measures were BI changes (BI on discharge - BI on admission) during rehabilitation (primary outcome) and length of stay (secondary outcome).


RESULTS
Anticholinergic drugs were prescribed in 38 patients (32.5%). Median and interquartile range for tAD = 0 (0-1); for ARS = 0 (0-1). Poisson regression showed that higher tAD (incidence rate ratio [IRR] = 0.92; 95% CI, 0.88-0.97; P = 0.003) and ARS scores (IRR = 0.97; 95% CI, 0.95-0.99; P = 0.008) on admission independently predicted lower BI changes. Being a woman (IRR = 0.87; 95% CI, 0.78-0.97; P = 0.01), lower Abbreviated Mental Test scores (IRR = 0.94; 95% CI, 0.91-0.97; P < 0.001), and lower BI on admission (IRR = 0.98; 95% CI, 0.97-0.98; P < 0.001), but not tAD or ARS scores, independently predicted increasing length of stay.


CONCLUSIONS
Higher anticholinergic drug exposure on admission independently predicts reduced functional outcomes, but not length of stay, in older patients undergoing orthopaedic rehabilitation.
Department of Rehabilitation Medicine, Woodend Hospital, NHS Grampian, Aberdeen, United Kingdom.
Sejlo
S
Koshoedo
Roy L
RL
Soiza
Rajib
R
Purkayastha
Arduino A
AA
Mangoni
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D003072:Cognition Disorders / Q000139:chemically induced / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male; D018727:Muscarinic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000534:rehabilitation*; D016012:Poisson Distribution; D011569:Psychiatric Status Rating Scales; D012606:Scotland / Q000453:epidemiology; D012727:Sex Characteristics; D011795:Surveys and Questionnaires
D018680:Cholinergic Antagonists; D018727:Muscarinic Antagonists