Introduction: Medication usage in older people is high and many commonly prescribed drugs have anticholinergic effects usually unwanted. Few studies have investigated the possible association between the use of anticholinergic drugs and mortality in oldest olds.
Methods: We analysed prospectively collected audit data from all acute medical admissions aged 90 years or more to hospitals in England and Scotland over a three month period. Baseline use of possible or definite anticholinergic drugs was determined according to the Anticholinergic Cognitive Burden Scale (ACB). Odds ratios for unadjusted and adjusted models for study outcomes were calculated. Risk ratios of outcomes according to ACB <2 and> = 2 in those with and without cardiovascular disease were examined. Adjusted models included all variables with a P-value of <0.10 from the univariate analysis of characteristics between ACB categories. The main outcome measures were in-hospital mortality, early in-hospital mortality at 3- and 7-days and in-patient length of stay.
Results: Of the 419 patients included (median age = 92.9, IQR 91.4–95.1 years), 256 (61.1%) were taking anticholinergic medications. Younger age, greater number of pre-morbid conditions, ischaemic heart disease, number of medications, higher urea and creatinine levels were significantly associated with higher total ACB burden on univariate regression analysis. There were no significant differences observed in terms of in-patient mortality, in-patient hospital mortality within 3- and 7-days and likelihood of prolonged length of hospital stay between ACB categories. Compared to those without cardiovascular disease, patients with cardiovascular disease showed similar outcome regardless of ACB load (either <2 or> = 2 ACB).
Conclusion: We found no evidence that anticholinergic burden at baseline predicted early (within 3- and 7-days) or later in-patient mortality, nor hospital length of stay in the oldest old in the acute medical admission setting.