Background Numerous studies demonstrate the association between the use of anticholinergic medication and cognitive impairment, as well as the increase in hospital readmissions, in chronic complex patients.
Purpose The objective of this study was to evaluate the anticholinergic risk in a sample of chronic complex patients and identify the responsible drugs.
Material and methods Prospective, cross-sectional, descriptive and observational study that included chronic complex patients older than 65 years, polymedicated (>5 prescribed drugs) and admitted to an acute hospital in September 2018. The variables registered were: demographic data, prescribed drugs, anticholinergic risk index (AR), Charlson index and degree of preventability of anticholinergic drugs. The data was collected from the electronic medical record during the therapeutic conciliation at admission made by the pharmacist. The Anticholinergic Burden Calculator was used to calculate the AR.
Results Twenty-four patients were included, with a mean age of 83 years (SD: 7). Of these, 16 (67%) were females. The average of the Charlson index was 6.75 (SD: 2.45). These patients were prescribed an average of 13 (SD: 5) drugs and, of these, an average of four (31%) anticholinergic drugs. According to the degree of AR, 11 patients (46%) had a high AR (AR >1), 11 (46%) medium and two (8%) low. The mean AR was 1.07 (SD: 0.81). One-hundred and eight prescriptions of anticholinergic drugs were registered, of which 12 (11%) were benzodiazepines, 12 (12%) antidepressants, five (5%) opioids, 11 (10%) diuretics, three (3%) urinary antispasmodics and 14 (13%) corticoids, among others. Sixty-seven per cent of patients had five or more anticholinergic drugs prescriptions. Based on the START/STOPP criteria, it was estimated that 27 prescriptions (25%) were avoidable in this group of patients.
Conclusion The prevalence of AR was important in the sample of patients. The AR could be avoided or reduced in at least a quarter of the prescriptions. One-third of the prescriptions corresponded to drugs of group N in the ATC classification. It would be interesting to establish selection criteria for patients who can benefit from a pharmaceutical intervention to try to minimise the anticholinergic risk.
References and/or acknowledgements Anticholinergic Burden Calculator:
No conflict of interes
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.