Korean J Intern Med. 2022;37(2):468-477.

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

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제1저자 최정연 · 교신저자 김광일

PMID 35176208 PMC8925946 DOI 10.3904/kjim.2021.457 IF 2.2 노인병내과

소속 (10)

Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea.
Institute of Health and Environment, Seoul National University, Seoul, Korea.
Institute on Aging, Seoul National University, Seoul, Korea.
Department of Environmental Health, Korea National Open University, Seoul, Korea.
Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 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 antagonistsKorean Anticholinergic Burden ScaleLong-term careMedication reviewPolypharmacy

Figures

**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).

그림 출처: PubMed Central 공개 논문 (PMC8925946)

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

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