title: Exposure to anticholinergic and sedative drugs, risk of falls, and mortality: an elderly inpatient, multicenter cohort.
abstract: This study aimed to assess whether exposure to anticholinergic and sedative medications and its evolution was associated with increased risk of in-hospital falls and all-cause mortality. Furthermore, results were compared with 2 definitions of drug burden index (DBI) against the outcomes.This observational, multicentric, and longitudinal study was conducted among patients aged 65 years or older, in 3 geriatric hospitals, in Francheville, Lyon, and Villeurbanne, France (duration of follow-up, 11.6 months). The exposure to anticholinergic and sedative medications was quantified using a DBI, at admission and at the end of observation for 337 patients. The evolution of exposure was the absolute difference between the index at admission and at the end of observation. The outcomes were in-hospital falls and all-cause mortality.Overall, 5.9% of patients experienced a fall. The risk of fall was nearly 3-fold in patients whose DBI increased during hospital stay compared to those with stable or decreased DBI (hazard ratio, 2.9 [1.14-7.12]; P = 0.03), after adjustment for comorbidities.The overall proportion of mortality was 6.5%. The evolution of DBI during hospital stay was not related to the risk of mortality (hazard ratio, 1.9 [0.8-4.4]; P = 0.14). Results were similar with the 2 definitions of DBI.Increased exposure to anticholinergic and sedative medications during hospital stay is associated with a higher risk of in-hospital falls but not with mortality. The DBI could be implemented in hospital, to guide prescription and reduce anticholinergic and sedative drug exposure.
authors.affiliation: From the *Centre Mémoire de Ressources et de Recherche de Lyon, and †Centre de Recherche Clinique-Vieillissement-Cerveau-Fragilité, Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne; ‡Hospices Civils de Lyon, Groupement Hospitalier, Service Pharmaceutique, Lyon; §Université Lyon 1, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne; and ∥Université Lyon 1, INSERM U1028; UMR CNRS 5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Dauphinot
authors.forename: Rémi
authors.initials: R
authors.lastname: Faure
authors.forename: Sélim
authors.initials: S
authors.lastname: Omrani
authors.forename: Sylvain
authors.initials: S
authors.lastname: Goutelle
authors.forename: Laurent
authors.initials: L
authors.lastname: Bourguignon
authors.forename: Pierre
authors.initials: P
authors.lastname: Krolak-Salmon
authors.forename: Christelle
authors.initials: C
authors.lastname: Mouchoux
mesh_terms: D000058:Accidental Falls / Q000401:mortality* / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007297:Inpatients / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D017751:Safety Management / Q000379:methods
chemical_list: D018680:Cholinergic Antagonists; D006993:Hypnotics and Sedatives