Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities.

Abstract

OBJECTIVES\nTo compare 3 internationally established criteria for drugs with anticholinergic properties (DAPs) and their associated factors in long-term care facilities, and to investigate the association between use of DAPs and psychological well-being (PWB) or mortality.\n\n\nDESIGN\nCross-sectional study and 1-year follow-up of all-cause mortality.\n\n\nSETTING AND PARTICIPANTS\nOf all 4449 residents living in long-term care facilities in Helsinki in 2011, 2432 (≥65\xa0years of age) participated after exclusion of residents with severe dementia.\n\n\nMEASUREMENTS\nData on demographics, medication use, and active diagnoses were collected by trained staff using structured questionnaires. DAP use was defined by the following 3 international criteria: Chew s list, the Anticholinergic Risk Scale, and the Anticholinergic Drug Scale. The total number of DAPs was counted and referred to as anticholinergic burden. PWB was assessed by a questionnaire and yielded a score ranging from 0 to 1. Mortality data was retrieved from central registers.\n\n\nRESULTS\nOf all participants, 85% were DAP users according to at least 1 of the 3 criteria used. Overlap between the 3 criteria was only moderate. DAP users were younger and a larger proportion of them had better cognition. However, they suffered more often from depression and other psychiatric diagnoses than nonusers. DAP users had lower PWB scores than those not using DAPs, and PWB decreased linearly in the overlapping groups from nonusers to those using DAPs according to all 3 criteria. The total number of DAPs used predicted mortality.\n\n\nCONCLUSIONS AND IMPLICATIONS\nDAP use and PWB appear to be negatively associated. When combining several criteria of DAPs, their burden predicted mortality. Clinicians should carefully consider the potential benefits and harms when prescribing DAPs to older persons.