TY - JOUR
T1 - The Association of Anticholinergic Drugs and Delirium in Nursing Home Patients With Dementia: Results From the SHELTER Study
AU - Oudewortel, Letty
AU - van der Roest, Henriëtte G.
AU - Onder, Graziano
AU - Wijnen, Viona J. M.
AU - Liperoti, Rosa
AU - Denkinger, Michael
AU - Finne-Soveri, Harriet
AU - Topinková, Eva
AU - Henrard, Jean-Claude
AU - van Gool, Willem A.
N1 - Funding Information: The SHELTER study was funded by the EU 7th Framework Program ( IGAMH-CR NS-10029-4 ). All researchers, including the coauthors, were independent from the funder, and the funding body did not play any role in the study design; in the collection, analysis, or interpretation of data; in manuscript preparation, or in the decision to submit the article for publication. Publisher Copyright: © 2021 The Authors
PY - 2021/10
Y1 - 2021/10
N2 - Objectives: Drugs with anticholinergic properties are associated with an increased prevalence of delirium, especially in older persons. The aim of this study was to evaluate the association between the use of this class of drugs in nursing home (NH) patients and prevalence of delirium, particularly in people with dementia. Design: Cross-sectional multicenter study. Setting and participants: 3924 nursing home patients of 57 nursing homes in 7 European countries participating in the Services and Health for Elderly in Long TERmcare (SHELTER) project. Methods: Descriptive statistics, calculation of percentage, and multivariable logistic analysis were applied to describe the relationship between anticholinergic drug use and prevalence of delirium in NH patients. The Anticholinergic Risk Scale (ARS) and the Anticholinergic Burden Scale (ACB) were used to calculate the anticholinergic load. Results: 54% of patients with dementia and 60% without dementia received at least 1 anticholinergic drug according to the ACB. The prevalence of delirium was higher in the dementia group (21%) compared with the nondementia group (11%). Overall, anticholinergic burden according to the ACB and ARS was associated with delirium both in patients with and without dementia, with odds ratios ranging from 1.07 [95% confidence interval (CI) 0.94-1.21] to 1.26 (95% CI 1.11-1.44). These associations reached statistical significance only in the group of patients with dementia. Among patients with dementia, delirium prevalence increased only modestly with increasing anticholinergic burden according to the ACB, from 20% (with none or minimal anticholinergic burden) to 25% (with moderate burden) and 27% delirium (with strong burden scores). Conclusions and Implications: The ACB scale is relatively capable to detect anticholinergic side effects, which are positively associated with prevalence of delirium in NH patients. Given the modest nature of this association, strong recommendations are currently not warranted, and more longitudinal studies are needed.
AB - Objectives: Drugs with anticholinergic properties are associated with an increased prevalence of delirium, especially in older persons. The aim of this study was to evaluate the association between the use of this class of drugs in nursing home (NH) patients and prevalence of delirium, particularly in people with dementia. Design: Cross-sectional multicenter study. Setting and participants: 3924 nursing home patients of 57 nursing homes in 7 European countries participating in the Services and Health for Elderly in Long TERmcare (SHELTER) project. Methods: Descriptive statistics, calculation of percentage, and multivariable logistic analysis were applied to describe the relationship between anticholinergic drug use and prevalence of delirium in NH patients. The Anticholinergic Risk Scale (ARS) and the Anticholinergic Burden Scale (ACB) were used to calculate the anticholinergic load. Results: 54% of patients with dementia and 60% without dementia received at least 1 anticholinergic drug according to the ACB. The prevalence of delirium was higher in the dementia group (21%) compared with the nondementia group (11%). Overall, anticholinergic burden according to the ACB and ARS was associated with delirium both in patients with and without dementia, with odds ratios ranging from 1.07 [95% confidence interval (CI) 0.94-1.21] to 1.26 (95% CI 1.11-1.44). These associations reached statistical significance only in the group of patients with dementia. Among patients with dementia, delirium prevalence increased only modestly with increasing anticholinergic burden according to the ACB, from 20% (with none or minimal anticholinergic burden) to 25% (with moderate burden) and 27% delirium (with strong burden scores). Conclusions and Implications: The ACB scale is relatively capable to detect anticholinergic side effects, which are positively associated with prevalence of delirium in NH patients. Given the modest nature of this association, strong recommendations are currently not warranted, and more longitudinal studies are needed.
KW - Delirium
KW - anticholinergic medications
KW - dementia
KW - nursing home patients
UR - http://www.scopus.com/inward/record.url?scp=85109065301&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jamda.2021.05.039
DO - https://doi.org/10.1016/j.jamda.2021.05.039
M3 - Article
C2 - 34197793
SN - 1525-8610
VL - 22
SP - 2087
EP - 2092
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 10
ER -