Impact of anticholinergic burden on emergency department visits among older adults in Korea: A national population cohort study

Sunghee Hwang, Kwanghee Jun, Young Mi Ah, Euna Han, Jee Eun Chung, Ju Yeun Lee

Research output: Contribution to journalArticle

Abstract

Objectives: This study aimed to evaluate the impact of high anticholinergic burden on overall emergency department (ED) visits and ED visits related to adverse effects of anticholinergic drugs among older adults. Methods: For this retrospective cohort study, we used claims data from older adults with high representativeness. The average daily Anticholinergic Risk Scale (ARS) score was calculated based on the dosage, treatment duration, and potency of anticholinergic drugs during three months. A high-exposure group (ARS ≥ 2) and a non-exposure group were included in this analysis. The primary outcome was the first ED visit during the follow-up period. Anticholinergic ED visits were defined as ED visits with a main diagnosis of a fall, fracture, dizziness, delirium, constipation, or urinary retention. Results: In total, 118,750 subjects (43.6% male) were included in this study. The mean age was 75.4 ± 6.6 years. The adjusted hazard ratios (aHRs) for all-cause and anticholinergic ED visits among those with high ARS scores were 1.28 (95% CI: 1.20–1.36) and 1.55 (95% CI: 1.38–1.74), respectively. The high-exposure group was at higher risk than the non-exposure group for ED visits for falls or fractures (aHR: 1.31, 95% CI: 1.07–1.60), dizziness (aHR: 1.71, 95% CI: 1.36–2.14), delirium (aHR: 2.05, 95% CI: 1.13–3.73), constipation (aHR: 1.65, 95% CI: 1.35–2.02) and urinary retention (aHR: 1.66, 95% CI: 1.30–2.12). Conclusions: This study demonstrated that a high anticholinergic burden in older adults increased the risk of all-cause ED visits, anticholinergic ED visits and specific-cause ED visits.

Original languageEnglish
Article number103912
JournalArchives of Gerontology and Geriatrics
Volume85
DOIs
Publication statusPublished - 2019 Nov 1

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Cholinergic Antagonists
Korea
Hospital Emergency Service
Cohort Studies
Population
cause
Group
drug
Urinary Retention
Delirium
Dizziness
Constipation
Pharmaceutical Preparations
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Health(social science)
  • Ageing
  • Gerontology
  • Geriatrics and Gerontology

Cite this

@article{18b5f95908ca435bb1ed9f14d6c593fb,
title = "Impact of anticholinergic burden on emergency department visits among older adults in Korea: A national population cohort study",
abstract = "Objectives: This study aimed to evaluate the impact of high anticholinergic burden on overall emergency department (ED) visits and ED visits related to adverse effects of anticholinergic drugs among older adults. Methods: For this retrospective cohort study, we used claims data from older adults with high representativeness. The average daily Anticholinergic Risk Scale (ARS) score was calculated based on the dosage, treatment duration, and potency of anticholinergic drugs during three months. A high-exposure group (ARS ≥ 2) and a non-exposure group were included in this analysis. The primary outcome was the first ED visit during the follow-up period. Anticholinergic ED visits were defined as ED visits with a main diagnosis of a fall, fracture, dizziness, delirium, constipation, or urinary retention. Results: In total, 118,750 subjects (43.6{\%} male) were included in this study. The mean age was 75.4 ± 6.6 years. The adjusted hazard ratios (aHRs) for all-cause and anticholinergic ED visits among those with high ARS scores were 1.28 (95{\%} CI: 1.20–1.36) and 1.55 (95{\%} CI: 1.38–1.74), respectively. The high-exposure group was at higher risk than the non-exposure group for ED visits for falls or fractures (aHR: 1.31, 95{\%} CI: 1.07–1.60), dizziness (aHR: 1.71, 95{\%} CI: 1.36–2.14), delirium (aHR: 2.05, 95{\%} CI: 1.13–3.73), constipation (aHR: 1.65, 95{\%} CI: 1.35–2.02) and urinary retention (aHR: 1.66, 95{\%} CI: 1.30–2.12). Conclusions: This study demonstrated that a high anticholinergic burden in older adults increased the risk of all-cause ED visits, anticholinergic ED visits and specific-cause ED visits.",
author = "Sunghee Hwang and Kwanghee Jun and Ah, {Young Mi} and Euna Han and Chung, {Jee Eun} and Lee, {Ju Yeun}",
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Impact of anticholinergic burden on emergency department visits among older adults in Korea : A national population cohort study. / Hwang, Sunghee; Jun, Kwanghee; Ah, Young Mi; Han, Euna; Chung, Jee Eun; Lee, Ju Yeun.

In: Archives of Gerontology and Geriatrics, Vol. 85, 103912, 01.11.2019.

Research output: Contribution to journalArticle

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T1 - Impact of anticholinergic burden on emergency department visits among older adults in Korea

T2 - A national population cohort study

AU - Hwang, Sunghee

AU - Jun, Kwanghee

AU - Ah, Young Mi

AU - Han, Euna

AU - Chung, Jee Eun

AU - Lee, Ju Yeun

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N2 - Objectives: This study aimed to evaluate the impact of high anticholinergic burden on overall emergency department (ED) visits and ED visits related to adverse effects of anticholinergic drugs among older adults. Methods: For this retrospective cohort study, we used claims data from older adults with high representativeness. The average daily Anticholinergic Risk Scale (ARS) score was calculated based on the dosage, treatment duration, and potency of anticholinergic drugs during three months. A high-exposure group (ARS ≥ 2) and a non-exposure group were included in this analysis. The primary outcome was the first ED visit during the follow-up period. Anticholinergic ED visits were defined as ED visits with a main diagnosis of a fall, fracture, dizziness, delirium, constipation, or urinary retention. Results: In total, 118,750 subjects (43.6% male) were included in this study. The mean age was 75.4 ± 6.6 years. The adjusted hazard ratios (aHRs) for all-cause and anticholinergic ED visits among those with high ARS scores were 1.28 (95% CI: 1.20–1.36) and 1.55 (95% CI: 1.38–1.74), respectively. The high-exposure group was at higher risk than the non-exposure group for ED visits for falls or fractures (aHR: 1.31, 95% CI: 1.07–1.60), dizziness (aHR: 1.71, 95% CI: 1.36–2.14), delirium (aHR: 2.05, 95% CI: 1.13–3.73), constipation (aHR: 1.65, 95% CI: 1.35–2.02) and urinary retention (aHR: 1.66, 95% CI: 1.30–2.12). Conclusions: This study demonstrated that a high anticholinergic burden in older adults increased the risk of all-cause ED visits, anticholinergic ED visits and specific-cause ED visits.

AB - Objectives: This study aimed to evaluate the impact of high anticholinergic burden on overall emergency department (ED) visits and ED visits related to adverse effects of anticholinergic drugs among older adults. Methods: For this retrospective cohort study, we used claims data from older adults with high representativeness. The average daily Anticholinergic Risk Scale (ARS) score was calculated based on the dosage, treatment duration, and potency of anticholinergic drugs during three months. A high-exposure group (ARS ≥ 2) and a non-exposure group were included in this analysis. The primary outcome was the first ED visit during the follow-up period. Anticholinergic ED visits were defined as ED visits with a main diagnosis of a fall, fracture, dizziness, delirium, constipation, or urinary retention. Results: In total, 118,750 subjects (43.6% male) were included in this study. The mean age was 75.4 ± 6.6 years. The adjusted hazard ratios (aHRs) for all-cause and anticholinergic ED visits among those with high ARS scores were 1.28 (95% CI: 1.20–1.36) and 1.55 (95% CI: 1.38–1.74), respectively. The high-exposure group was at higher risk than the non-exposure group for ED visits for falls or fractures (aHR: 1.31, 95% CI: 1.07–1.60), dizziness (aHR: 1.71, 95% CI: 1.36–2.14), delirium (aHR: 2.05, 95% CI: 1.13–3.73), constipation (aHR: 1.65, 95% CI: 1.35–2.02) and urinary retention (aHR: 1.66, 95% CI: 1.30–2.12). Conclusions: This study demonstrated that a high anticholinergic burden in older adults increased the risk of all-cause ED visits, anticholinergic ED visits and specific-cause ED visits.

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