Factors associated with anticholinergic burden among older patients in long-term care hospitals in Korea

Abstract

Background/aims: Drugs with anticholinergic properties (DAPs) are associated with adverse health outcomes in older patients. The objective of this study was to evaluate the factors that determine the prescribing of more DAPs in long-term care hospitals (LTCHs) in Korea. In addition, the current patterns of DAP prescription were explored using a novel platform, which can collect data from LTCHs.

Methods: This was a Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) sub-study, which is a pragmatic, cluster-randomized, controlled trial. The Health-RESPECT platform was used to collect prescribed medication data of 466 patients (aged ≥ 65 years) from seven LTCHs. DAPs were identified using the Korean Anticholinergic Burden Scale (KABS). Physical frailty, cognitive function, functional status, and quality of life were evaluated.

Results: Among 466 LTCH patients, 88.8% (n = 414) were prescribed DAPs, and the prevalence of high KABS (≥ 3) was 70.4% (n = 328). The drugs that contributed most to the total KABS were quetiapine (20.7%), chlorpheniramine (19.5%), tramadol (9.8%), cimetidine (5.8%), and furosemide (3.6%). Polypharmacy, higher body mass index, less dependence, better communication and cognitive functions, and poorer quality of life were associated with high KABS.

Conclusion: Although the patients with a high burden of DAPs were less dependent and had better cognitive and communication functions, they had poorer quality of life. DAP use in LTCH patients should be monitored carefully, and the risk/ benefit relationship for their use should be considered.

Keywords: Cholinergic antagonists; Korean Anticholinergic Burden Scale; Long-term care; Medication review; Polypharmacy.

Figure 1

Distribution of (A) Korean Anticholinergic Burden Scale (KABS) score of medications and (B) specific medications that contributed to the total KABS burden of the study population. Medications of KABS scores 1, 2, and 3 contributed 27%, 38%, and 35%, respectively, to the total KABS burden. The top five medications with the highest contribution to the total KABS burden were quetiapine (21%), chlorpheniramine (19%), tramadol (10%), cimetidine (6%), and furosemide (4%).

Figure 2

Quality of life score according to the anticholinergic burden: no anticholinergic medication (Korean Anticholinergic Burden Scale [KABS] 0), intermediate burden of anticholinergic medications (KABS 1–2), and high burden of anticholinergic medications (KABS 3 or more). There was a significant difference in the quality of life score according to the anticholinergic burden (KABS 0 vs. 3 or more, p = 0.01).