Background Anticholinergic burden of medications has been linked to a number of adverse outcomes in older adults. It has demonstrated a negative impact on health outcomes such as cognitive impairment or falls, and many studies have recently investigated the association with a higher risk of mortality, but findings are contradictory.
Purpose To summarise with a systematic review of the evidence regarding the association between the anticholinergic burden of medications and mortality in older adults.
Material and methods A scientific literature search was conducted to identify all relevant studies published from 2006 until May 2018, without applying language restrictions. Queries of the literature were performed using the electronic databases PubMed (MEDLINE), EMBASE, Web of Science, CENTRAL and PsycINFO. A combination of the following search terms was used: ‘aged’ AND ‘anticholinergic’ AND ‘mortality’. Studies with any type of design and setting with participants of mean age 65 years or older were included.
Results Two-thousand and twenty-eight different studies were identified, and after a two-step review, 34 were finally included in the systematic review (total 1,142,613 participants, from 71 to 537,387). All of them were observational studies: one case-control study and 33 cohort studies (nine retrospective and 24 prospective). Fourteen different scales were used: Anticholinergic Risk Scale, Drug Burden Index and Anti-Cholinergic Burden Scale were the most commonly used. Thirteen studies were performed in a hospital setting, seven in nursing homes, seven in a community dwelling, four were population-based studies and the rest used mixed populations. Follow-up periods differed from length of hospital stay to 10 years. Eighteen of 34 studies found a significant association between the anticholinergic burden of medications and an increased risk of mortality, in different settings and with different anticholinergic scales (six of 13 studies with hospitalised patients).
Conclusion A high anticholinergic burden may increase the risk of mortality in older adults, but further well-designed research is needed to confirm this finding. A reduction of anticholinergic burden could be a cautious strategy to reduce the risk of mortality and other adverse outcomes. Hospital is a suitable setting to perform medication reviews in older adults to reduce this risk and clinical pharmacists can play an important role for this purpose.
References and/or acknowledgements No conflict of interest.
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