Anticholinergic Medication Burden and 5-Year Risk of Hospitalization and Death in Nursing Home Elderly Residents With Coronary Artery Disease

J Am Med Dir Assoc. 2016 Nov 1;17(11):1056-1059. doi: 10.1016/j.jamda.2016.07.012. Epub 2016 Aug 31.


Objectives: To assess the association of the anticholinergic medication burden with hospitalization and mortality in nursing home elderly patients and to investigate the role of coronary artery disease (CAD).

Design: Longitudinal (5-year) retrospective observational study.

Setting: Nursing homes in Italy.

Participants: A total of 3761 nursing home older residents.

Measurements: A comprehensive clinical and functional assessment was carried out through the interRAI long-term care facility instrument. The anticholinergic burden was assessed through the anticholinergic cognitive burden (ACB) scale. Occurrence of hospitalization/all-cause mortality was the primary composite outcome. First hospitalization and all-cause mortality were the secondary outcomes of the study. Hazard ratios (HRs) and subdistribution HRs were obtained through Cox and competing risk (death as competing event for hospitalization) models.

Results: Within the sample (mean age 83 ± 7 years; 72% females) the incidence rate of the primary outcome was 10/100 person-year. After adjusting for potential confounders and compared with participants with an ACB of 0, those with an ACB of 1 [HR 1.46; 95% confidence interval (CI) 1.12-1.90] and ABC of 2+ (HR 1.41; 95% CI 1.11-1.79) presented an increased risk of developing the primary outcome. After stratification, the risk for the primary outcome increased along with the anticholinergic burden, only for participants affected by CAD (HR 1.53; 95% CI 0.94-2.50 and HR 1.71; 95% CI 1.09-2.68 for the ACB of 1 and ACB of 2+ groups). An ACB score of 2+ was marginally associated with first hospitalization, considering death as a competing risk, only for those with CAD (subdistribution HR 3.47; 95% CI 0.99-12.3).

Conclusions: Anticholinergic medication burden is associated to hospitalization and all-cause mortality in institutionalized older adults. CAD increases such risk. The effectiveness and safety profile of complex drug regimens should be reconsidered in this population.

Keywords: Anticholinergics; hospitalization; ischemic heart disease; mortality; nursing home.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cholinergic Antagonists / adverse effects*
  • Coronary Artery Disease / drug therapy*
  • Female
  • Hospitalization*
  • Humans
  • Italy
  • Longitudinal Studies
  • Male
  • Mortality / trends*
  • Nursing Homes*
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Risk Assessment


  • Cholinergic Antagonists