Geriatrik Popülasyonda Antikolinerjik Yükün Sağkalım Üzerine Etkisinin Değerlendirilmesi

Abstract

Anticholinergic burden is defined as the cumulative dose of 1 or more anticholinergic medicines’ activity. Measurement of anticholinergic burden based on different methods, determining the serum anticholinergic activity, determining the muscarinic activity at the receptor level or expert opinion can be used. Different scales have been developed for the determination of anticholinergic burden. Although many scales have been developed there is no gold standard approach to determine the anticholinergic burden in older people. Anticholinergic burden has been associated with various geriatric conditions, including falls, delirium, sarcopenia, and malnutrition, but recent studies have also shown its potential link to reduced survival time, making it more clinically significant. This study aimed to identify the association between the anticholinergic burden and survival time in a geriatric population. Data from 2801 patients aged 65 and over who passed away between January 1, 2013, and January 1, 2020 were included Anticholinergic burden scales Anticholinergic Cognitive Burden (ACB) and Anticholinergic Burden Classification (ABC) were used. Then anticholinergic burden points were categorized into 3 groups none, low/possible, and high. The association with anticholinergic burden on survival was analyzed over 12 months, 60 months, and 120 months, and Kaplan-Meier survival curves were compared for each year. Regression analyses were performed for high anticholinergic burden, male gender, multimorbidity, age, and frailty. The median age was 79.8 and 53.3% of the patients were female. The study's findings showed that a high ACB was associated with a 1.2-fold increase (95% CI: 1.02-1.41, p=0.03) in 1-year mortality and a 1.15-fold increase (95% CI: 1.04-1.28, p=0.006) in 10-year mortality. Additionally, the study observed that high and low ABC were linked to a 1.21-fold higher risk (95% CI:1.02-1.43, p=0.03) of 1-year mortality and a 1.27-fold higher risk (95% CI: 1.14-1.41, P<0.001) of 10-year mortality. The comparison of Kaplan-Meier curves unveiled a notable decline in the probability of survival time for patients with a high anticholinergic burden, affecting both short-term and long-term outcomes. Although the ABC scale is not used to evaluate many mortality studies in the literature; our study showed that the ABC scale is also an anticholinergic scale that can be used to predict both short-term and long-term survival time. Therefore, all physicians interested in the geriatric population should be aware of the anticholinergic burden and its relationship with survival time. This finding should be further supported by future studies.