Polypharmacotherapy and cumulative anticholinergic burden in older
adults hospitalised with fall
Abstract
Background and Purpose Polypharmacotherapy is a growing phenomenon
associated with adverse effects in older adults. We assessed the
potential confounding effects of cumulative anticholinergic burden (ACB)
in patients who were hospitalised with falls. Methods A
non-interventional, prospective cohort study of unselected, acute
admissions aged ≥65 years. Data were derived from electronic patient
health records. Results were analysed to determine the frequency of
polypharmacotherapy and degree of ACB and their relationship to falls
risk. Primary outcomes were polypharmacotherapy, defined by ≥5
medications, and ACB score. Key Results 411 consecutive subjects were
included, mean age 83·8 ± 8·0 years: 40·6% male. 38·4% were admitted
with fall. Incidence of polypharmacotherapy was 80·8%, (88·0% and
76·3% among those admitted with and without fall respectively).
Incidence of ACB score of 0, 1, 2, ≥3 was 38·7%, 20·9%, 14·6% and
25·8% respectively. On multivariate analysis, age (OR=1·03, [1·0 ;
1·05], p= 0·0494), ACB score (OR=1.15, [1.02 ; 1.29], p= 0.0245),
polypharmacotherapy (OR=2·14, [1·19 ; 3·87], p= 0·0115) but not
Charlson Comorbidity Index (OR=0·92, [0·81 ; 1·04], p= 0·1723) were
significantly associated with higher falls rate. Of patients admitted
with fall, 29·8% had drug-related orthostatic hypotension, 24·7% had
drug-related bradycardia, 37·3% were prescribed centrally acting drugs
and 12·0% were taking inappropriate hypoglycaemic agents.
Interpretation Polypharmacotherapy results in cumulative ACB and both
are significantly associated with falls risk in older adults. The
presence of polypharmacotherapy and each unit rise in ACB score have a
stronger effect of increasing falls risk compared to age and
comorbidities.