Reactions Weekly | 2021
Drugs with anticholinergic properties increase risk of death in elderly
Abstract
Drugs with anticholinergic properties (DAP) increase the risk of death in older adults, according to findings of a nationwide Danish study published in Drugs Real World Outcomes. Data from four national registers in Denmark were used to investigate the association between DAP use at hospital admission and the risk of all-cause mortality in 74 589 patients 65 years of age or over (median 83 years) admitted to a Danish geriatric department between 2005 and 2014, and followed up until the end of 2015. The anticholinergic cognitive burden (ACB) score and number of DAP at admission were determined for each patient. Overall, 62.5% of patients received one or more DAP, and DAP use significantly increased mortality compared with no use of DAP (p<0.001). Compared with no use, the mortality risk was significantly higher in DAP users with an ACB score of 2 at admission, at 30 days (adjusted hazard ratio [aHR] 1.46; 95% CI 1.32, 1.61), one year (aHR 1.34; 95% CI 1.28, 1.41), and overall (aHR 1.27; 95% CI 1.23, 1.31). Similarly, the mortality risk was significantly higher in patients using five or more DAP at admission versus non users, at 30 days (aHR 1.46; 95% CI 1.09, 1.95), one year (aHR 1.48; 95% IC 1.29, 1.70), and overall (aHR 1.44; 95% CI 1.31, 1.59). This study demonstrated a significant association between the use of DAP at hospital admission and all-cause mortality in older geriatric patients even when adjusting for other important variables such as comorbidity and ADL,* said the authors. Our study may ease the feasibility of deprescribing for clinicians, as a simple cumulative count of DAP is easier to administer than calculating an ACB score. Reduction of the use of DAP is feasible but challenging in a real-life setting, they added.