title: The relationship between total anticholinergic burden (ACB) and early in-patient hospital mortality and length of stay in the oldest old aged 90 years and over admitted with an acute illness.
abstract: The use of prescription drugs in older people is high and many commonly prescribed drugs have anticholinergic effects. We examined the relationship between ACB on mortality and in-patient length of stay in the oldest old hospitalised population. This was a retrospective analysis of prospective audit using hospital audit data from acute medical admissions in three hospitals in England and Scotland. Baseline use of possible or definite anticholinergics was determined according to the Anticholinergic Cognitive Burden Scale. The main outcome measures were decline in-hospital mortality, early in-hospital mortality at 3- and 7-days and in-patient length of stay. A total of 419 patients (including 65 patients with known dementia) were included [median age=92.9, inter-quartile range (IQR) 91.4-95.1 years]. 256 (61.1%) were taking anticholinergic medications. Younger age, greater number of pre-morbid conditions, ischemic heart disease, number of medications, higher urea and creatinine levels were significantly associated with higher total ACB burden on univariate regression analysis. There were no significant differences observed in terms of in-patient mortality, in-patient hospital mortality within 3- and 7-days and likelihood of prolonged length of hospital stay between ACB categories. Compared to those without cardiovascular disease, patients with cardiovascular disease showed similar outcome regardless of ACB load (either =0 or >0 ACB). We found no association between ACB and early (within 3- and 7-days) and in-patient mortality and hospital length of stay outcomes in this cohort of oldest old in the acute medical admission setting.
authors.affiliation: Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island; Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, Norfolk Island. Electronic address: andrewcraigkidd@yahoo.co.uk.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Kidd
authors.affiliation: Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island.
authors.forename: Patrick
authors.initials: P
authors.lastname: Musonda
authors.affiliation: Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom; School of Medicine & Dentistry, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom.
authors.forename: Roy L
authors.initials: RL
authors.lastname: Soiza
authors.affiliation: Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Butchart
authors.affiliation: Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom.
authors.forename: Claire J
authors.initials: CJ
authors.lastname: Lunt
authors.affiliation: University Hospital of South Manchester, Manchester M23 9LT, United Kingdom.
authors.forename: Yogish
authors.initials: Y
authors.lastname: Pai
authors.affiliation: Norfolk & Waveney Mental Health Care Trust, Norwich NR6 5BE, United Kingdom.
authors.forename: Yasir
authors.initials: Y
authors.lastname: Hameed
authors.affiliation: Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island.
authors.forename: Chris
authors.initials: C
authors.lastname: Fox
authors.affiliation: Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island; Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, Norfolk Island.
authors.forename: John F
authors.initials: JF
authors.lastname: Potter
authors.affiliation: Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom; School of Medicine & Dentistry, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom. Electronic address: phyo.myint@abdn.ac.uk.
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000008:administration & dosage*; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology
chemical_list: D018680:Cholinergic Antagonists
keywords: ACB; Length of stay; Mortality; Oldest old