INCREASED MORTALITY AND DELIRIUM FROM ANTICHOLINERGIC DRUGS IN NURSING HOME RESIDENTS TAKING ANTIDEMENTIA DRUGS

Abstract Anticholinergic drugs (ACDs) increase the risk of mortality and delirium in older adults. In patients with dementia, while anti-dementia drugs (ADDs) may counteract with ACDs, it is not known if those taking ADDs still have significant adverse effects from ACDs. Previous studies are also li...

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Bibliographic Details
Published in:Innovation in aging Vol. 2; no. suppl_1; p. 942
Main Authors: Sato, I, Sato, T, Crystal, S, Sato, D, Sato, S
Format: Journal Article
Language:English
Published: US Oxford University Press 01.11.2018
Subjects:
Abstracts
Anticholinergics
Cognitive ability
Delirium
Dementia
Drugs
Mortality
Nursing homes
ISSN:2399-5300, 2399-5300
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Summary:Abstract Anticholinergic drugs (ACDs) increase the risk of mortality and delirium in older adults. In patients with dementia, while anti-dementia drugs (ADDs) may counteract with ACDs, it is not known if those taking ADDs still have significant adverse effects from ACDs. Previous studies are also limited by unmeasured confounding by functional status. We investigated whether ACDs increase the risk of mortality and delirium in older nursing home (NH) residents taking ADDs after accounting for cognitive function and physical function. We conducted a new user design cohort study using Medicare data and the Minimum Data Set including all long-term NH residents aged ≥65 (7/2007–12/2013). We identified patients who have at least one diagnosis and at least one prescription for ADDs (donepezil, galantamine, rivastigmine, and memantine). The exposure was a new use of ACDs (e.g., mirtazapine, loperamide, and promethazine). Primary outcomes included all-cause deathand delirium defined using validated algorithms. We used Cox regression to adjust for socio-demographics, comorbidities, co-medications, cognitive function, and functional status. We identified 105,125 subjects with dementia (mean age 84.7, 73.2% female). Users of ACDs (n= 31,027, 29.5%) were more likely to have anxiety or depression but had a better cognitive function. Adjusted hazard ratios (HRs) for mortality was 3.8 (95% CI, 3.0–4.7), and for delirium was 1.5 (95%CI,1.3–1.6). ACDs were associated with an 1.5–3.8 fold increased risk of mortality and delirium among NH residents with dementia taking ADDs even after adjusting for potential confounders. Clinicians should be aware of these risks when prescribing ACDs in institutionalized patients with dementia.
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ISSN:2399-5300
2399-5300
DOI:10.1093/geroni/igy031.3498