title: Exposure to atropinic drugs and frailty status.
abstract: BACKGROUND
  Atropinic drugs can increase the risk of falls, cognitive impairment, and mortality in older patients; however, whether exposure to atropinic drugs is associated with frailty status remains unknown. Our aim was to assess the association between frailty status and exposure to atropinic drugs in a geriatric day hospital population.
  
  
  METHODS
  We carried out a cross-sectional study that included all the patients consulting for the first time at the Geriatric Frailty Clinic for Assessment of Frailty and Prevention of Disability in Toulouse, France, from January 2013 to October 2013. Frailty was defined by 3 or more of Fried et al's criteria. Atropinic drugs were those with clinical antimuscarinic effect from the Anticholinergic Drug Scale (excluding drugs weighted 1 point and not listed by Durán et al) and from Laroche et al list (to include drugs marketed in France not present in the Anticholinergic Drug Scale). To explore a dose-effect relationship, we calculated the atropinic burden using the Anticholinergic Drug Scale weights. We performed logistic regression models adjusted for age, gender, comorbidities, being community dwelling or not, cognitive status, educational level, and polypharmacy (≥6 drugs).
  
  
  RESULTS
  We included 437 patients (227 frail and 210 robust or prefrail). Exposure to at least one atropinic drug was associated with frailty (odds ratio 1.97, 95% confidence interval 1.10-3.53, P = .02). Due to a statistically significant interaction between age and atropinic burden, a dose-effect relationship for atropinic burden was explored in patients younger than 85 years, showing a significant association between atropinic burden score and frailty (P = .01). The Odds ratio for an atropinic burden greater than or equal to 3 versus 0 was 3.84, 95% confidence interval 1.43-10.34 (P < .01).
  
  
  CONCLUSIONS
  In a geriatric day hospital, population frailty is associated with a high atropinic burden.
authors.affiliation: Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France; Département Universitaire de Médecine Générale, Toulouse, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Moulis
authors.affiliation: Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Service de Médecine Interne, CHU de Toulouse, Toulouse, France. Electronic address: guillaume.moulis@univ-tlse3.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Moulis
authors.affiliation: Gerontopôle, CHU de Toulouse, Toulouse, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Balardy
authors.affiliation: Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gérard
authors.affiliation: Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France; Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, CHU de Toulouse, Toulouse, France.
authors.forename: François
authors.initials: F
authors.lastname: Montastruc
authors.affiliation: Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Sourdet
authors.affiliation: Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France; Département Universitaire de Médecine Générale, Toulouse, France.
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Rougé-Bugat
authors.affiliation: Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
authors.affiliation: Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France; Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, CHU de Toulouse, Toulouse, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Montastruc
authors.affiliation: Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Rolland
authors.affiliation: Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004363:Drug Utilization; D005260:Female; D016330:Frail Elderly; D005602:France; D015577:Geriatric Assessment / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020380:Needs Assessment; D018570:Risk Assessment; D018709:Statistics, Nonparametric
chemical_list: D018680:Cholinergic Antagonists
keywords: Frailty; anticholinergic drug; atropinic burden