Citation

Wong HL, Mandal AKJ, Weaver C, Chauhan R, Missouris CG. Br. J. Clin. Pharmacol. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, John Wiley and Sons)

DOI

10.1111/bcp.15753

PMID

37137729

Abstract

It is evident that polypharmacy among older adults results in increased cumulative anticholinergic exposure and several adverse outcomes. We read with interest and congratulate Hilmer et al. on their multicentre cohort study in Australia, investigating the association between cumulative anticholinergic and sedative medication exposure and adverse outcomes. The authors conclude that potentially inappropriate medications (PIMS) and drug burden index (DBI) are significantly associated with increased risks of fall and delirium.1

We would like to share our experience from the United Kingdom where polypharmacy is a known and growing phenomenon associated with adverse effects in older adults.2 We investigated the potential confounding effects of polypharmacy and cumulative anticholinergic burden (ACB) in older adults hospitalized with fall.

We prospectively evaluated 411 consecutive patients aged ≥65 years (mean age 83.8 ± 8.0 years: 40.6% male) admitted acutely to hospital. Pharmacological reconciliation was carried out by hospital pharmacists utilizing the national patient database: NHS Summary Care Record, which contains all regular and acute medication prescriptions. Incidence of polypharmacy (defined as prescription of ≥5 regular oral medications), ACB score (http://www.acbcalc.com/) and Charlson Comorbidity Index (CCI) were recorded and compared between patients admitted with or without fall. We further evaluated the association between polypharmacy, summative ACB score, CCI, age and falls risk...

Language: en