An anticholinergic burden score for German prescribers: score development

BMC Geriatrics, Год журнала: 2018, Номер 18(1)

Опубликована: Окт. 10, 2018

Anticholinergic drugs put elderly patients at a higher risk for falls, cognitive decline, and delirium as well peripheral adverse reactions like dry mouth or constipation. Prescribers are often unaware of the drug-based anticholinergic burden (ACB) their patients. This study aimed to develop an score licensed in Germany be used by clinicians prescribing level. A systematic literature search pubmed assessed previously published ACB tools. Quantitative grading scores were extracted, reduced available Germany, reevaluated expert discussion. Drugs scored having no, weak, moderate, strong effects. Further identified clinical routine included well. The 692 different drugs, with 548 Germany. After exclusion due no systemic effect scoring drug combinations (n = 67) evaluation 26 additional routine, 504 scored. Of those, 356 categorised 104 18 moderate 29 newly created authorized can daily practice reduce potentially inappropriate medications studies investigating its on reducing side effects necessary validation.

Язык: Английский

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Anticholinergic Drug Burden Tools/Scales and Adverse Outcomes in Different Clinical Settings: A Systematic Review of Reviews

Drugs & Aging, Год журнала: 2018, Номер 35(6), С. 523 - 538

Опубликована: Май 8, 2018

Язык: Английский

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Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease

PLoS ONE, Год журнала: 2016, Номер 11(3), С. e0150621 - e0150621

Опубликована: Март 3, 2016

Background Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on burden are limited in subpopulations, such as individuals Parkinson disease (PD). The objective this study was to determine whether associated outcomes a PD inpatient population. Methods Using Cerner Health Facts® database, we retrospectively examined medication use, diagnoses, hospital revisits within cohort 16,302 inpatients admitted between 2000 2011. Anticholinergic computed using Risk Scale (ARS). Primary were associations ARS score diagnosis fracture delirium. Secondary included 30-day revisits. Results Many (57.8%) prescribed non-PD moderate very strong potential. Individuals greatest (≥4) more likely be diagnosed fractures (adjusted odds ratio (AOR): 1.56, 95% CI: 1.29–1.88) delirium (AOR: 1.61, 1.08–2.40) relative those no burden. Similarly, visit emergency department hazard (AHR): 1.32, 1.10–1.58) readmitted (AHR: 1.16, 1.01–1.33) 30-days discharge. Conclusions We found positive association increased among PD. Additional pharmacovigilance studies needed better understand risks use

Язык: Английский

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Anticholinergic Drug Burden and Delirium: A Systematic Review

Journal of the American Medical Directors Association, Год журнала: 2020, Номер 22(1), С. 65 - 73.e4

Опубликована: Июль 20, 2020

ObjectivesTo investigate the association between anticholinergic drug burden (ADB), measured with scales, and delirium severity.DesignSystematic review.Setting ParticipantsAll available studies.MethodsA systematic literature search was performed in Medline, Embase, PsycINFO, Web of Science, CINAHL, Cochrane library, Google Scholar. Studies evaluating ADB (measured as a total score) or severity, published English, were eligible for inclusion.ResultsSixteen studies, including 148,756 persons, included. Fifteen studies investigated delirium. Anticholinergic Risk Scale (ARS, n = 5), Cognitive Burden (ACB, 6), list Chew (n 1), Drug (ADS, modified version ARS ACB 1). A high ADB, ARS, associated (5/5). Also ACB, an found during 3-month (1/1) 1-year follow-up (1/1), respectively. When assessed other results inconclusive, only 1 positive (1/6) ADS (1/5) each. The possible severity has also been (ADS 2, Summers Number One study ADS, increase delirium.Conclusions ImplicationsADB is consistently versions needs confirmation. findings inconclusive. current suggest that might be useful tool to identify patients at increased risk

Язык: Английский

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Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review

European Journal of Clinical Pharmacology, Год журнала: 2020, Номер 77(2), С. 147 - 162

Опубликована: Окт. 3, 2020

Abstract Purpose Older people are at risk of anticholinergic side effects due to changes affecting drug elimination and higher sensitivity drug’s effects. Anticholinergic burden scales (ABS) were developed quantify the (ADB). We aim identify all published ABS, compare them systematically evaluate their associations with clinical outcomes. Methods conducted a literature search in MEDLINE EMBASE ABS Web Science citation (WoS) analysis track validation studies implying Quality was assessed using an adapted AGREE II tool. For studies, we used Newcastle-Ottawa Scale Cochrane tool Rob2.0. The categorized into six evidence levels based on propositions Oxford Center for Evidence-Based Medicine respect quality. At least two researchers independently performed screening quality assessments. Results Out 1297 records, identified 19 104 validations studies. Despite differences quality, recommended use. cognitive (ACB) scale German (GABS) achieved highest percentage Most validated, yet newer lacking. Only compared eight simultaneously. four most investigated outcomes delirium, cognition, mortality falls showed contradicting results. Conclusion There is need good comparing multiple define best conduct meta-analysis assessment impact.

Язык: Английский

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Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome

Cochrane library, Год журнала: 2021, Номер 2021(5)

Опубликована: Май 5, 2021

Язык: Английский

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Anticholinergic burden and cognitive function in a large German cohort of hospitalized geriatric patients

PLoS ONE, Год журнала: 2017, Номер 12(2), С. e0171353 - e0171353

Опубликована: Фев. 10, 2017

Previous studies suggest an association between use of anticholinergic drugs in elderly patients and cognitive impairment. However, there are still limited data on the drug impairment as well contribution individual to load using large, well-documented patient cohorts treated geriatric units from Europe.We investigated 797,440 prescriptions 89,579 hospitalized within GiB-DAT database. Data all discharged 1 January 2013 30 June 2015 was included. The Anticholinergic Cognitive Burden (ACB) scale used classify definite (score 2 or 3) possible anticholinergics 1). function determined Mini-Mental State Examination (MMSE) standardized for dementia (4D+S).In two multivariable logistic regression models age, sex, number ACB total scores were identified variables independently associated with measured by MMSE (odds ratio per unit 1.114, 95% CI 1.099-1.130) diagnosis 1.159 unit, 1.144-1.173, both p < 0.0001). High severe (p 0.05 pairwise comparisons). score 3 contributed 77.9% cumulative amount points higher.Using a cross-sectional study design, significant positive European specialised found. most frequently definitve quetiapine, amitriptyline carbamazepine.

Язык: Английский

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Development of an Anticholinergic Burden Scale specific for Korean older adults

Geriatrics and gerontology international/Geriatrics & gerontology international, Год журнала: 2019, Номер 19(7), С. 628 - 634

Опубликована: Апрель 29, 2019

The aim of this study was to develop the Korean Anticholinergic Burden Scale through assessment previously developed tools, a literature review and modified Delphi process.We carried out systematic identify published anticholinergic burden tools. A composite medication list made by extracting medications their quantitative grading from existing after excluding not distributed in Korea topical agents. We also added available that had been rated. For with conflicting scores or no score, we determined final score 0 ("no effect") 3 ("strong expert consensus two-round process.A 655 extracted 10 total 38 were list. 494 deemed suitable for Korean-specific scale. confirmed 352 scales, 142 underwent process. graded experts showed high reliability among an intra-class correlation 0.98 (95% confidence interval 0.97-0.98). Finally, 56 categorized as strong anticholinergics, 23 moderate, 59 weak 356 having activity.This newly created consensus-driven scale designed specifically healthcare system might be practical tool assessing older adults polypharmacy routine reviews research. Geriatr Gerontol Int 2019; 19: 628-634.

Язык: Английский

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Assessing Risks of Polypharmacy Involving Medications With Anticholinergic Properties

The Annals of Family Medicine, Год журнала: 2020, Номер 18(2), С. 148 - 155

Опубликована: Март 1, 2020

PURPOSE

Anticholinergic burden (ACB), the cumulative effect of anticholinergic medications, is associated with adverse outcomes in older people but less studied middle-aged populations. Numerous scales exist to quantify ACB. The aims this study were ACB a large cohort using 10 most common scales, assess association each scale outcomes, and overlap populations identified by scale.

METHODS

We performed longitudinal analysis UK Biobank community (502,538 participants, baseline age: 37-73 years, median years follow-up: 6.2). was calculated at scales. Baseline data linked national mortality register records hospital episode statistics. primary outcome composite all-cause major cardiovascular event (MACE). Secondary mortality, MACE, admission for fall/fracture, dementia/delirium. Cox proportional hazards models (hazard ratio [HR], 95% CI) quantified associations between adjusted age, sex, socioeconomic status, body mass index, smoking alcohol use, physical activity, morbidity count.

RESULTS

medication use varied from 8% 17.6% depending on used. For outcome, significantly mortality/MACE Drug Scale strongly (HR = 1.12; CI, 1.11-1.14 per 1-point increase score). all secondary outcomes. Effect Cognition dementia/delirium 1.45; 1.3-1.61 increase).

CONCLUSIONS

middle- older-aged population. Populations size differed choice influenced population as potentially requiring reduction clinical practice or intervention trials.

Язык: Английский

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Anticholinergic burden: considerations for older adults

Journal of Pharmacy Practice and Research, Год журнала: 2016, Номер 47(1), С. 67 - 77

Опубликована: Дек. 23, 2016

Abstract Anticholinergic medications are frequently used in older adults to manage a wide range of chronic diseases. burden associated with the use multiple anticholinergic effects is cumulative within an individual, and particularly susceptible adverse these medications. These include dry mouth resulting poor oral health, constipation, urinary retention confusion. Use has been impaired cognitive physical function, increased risk falls, vascular events hospitalisation. Consideration important component medication management for adults. Several measures have developed validated quantify burden, such as Drug Scale, Risk Scale Cognitive Burden scale. However, evidence translation into clinical practice limited. This narrative review provides brief overview pharmacology context adults, summarises approaches measure reviews recent impact discusses deprescribing strategies practice.

Язык: Английский

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