Prevalence, risk factors and adverse outcomes of anticholinergic burden in patients with advanced chronic conditions at hospital admission

Geriatr Gerontol Int. 2018 Aug;18(8):1159-1165. doi: 10.1111/ggi.13330. Epub 2018 Apr 11.


Aim: To evaluate the anticholinergic burden (ACB), the risk factors associated with its onset and the clinical consequences for patients with advanced chronic conditions.

Methods: A 10-month cross-sectional study was carried out in an acute hospital care geriatric unit. Patients with advanced chronic conditions were identified by the NECessity of PALliative care (NECPAL) test. The ACB was established using the Anticholinergic Drug Scale and Drug Burden Index (DBI) tools. Demographic, pharmacological and clinical patient data were collected with the objective of determining risk factors related to ACB. Measured clinical outcomes were the presence of acute confusional state, bone fractures, length of stay, mortality and 12-month survival rate.

Results: A total of 235 patients were recruited (mean age 86.80 years, SD 5.37 years; 65.50% women), and 82.10% (DBI) and 93.6% (Anticholinergic Drug Scale) of the patients were treated with anticholinergic medications. Excessive polypharmacy (≥10 drugs) was identified as a risk factor for the presence of anticholinergic medication (Anticholinergic Drug Scale: OR 6.26, 95% CI 1.38-28.42; DBI: OR 3.44, 95% CI 1.60-7.38). High anticholinergic burden (by DBI >2 points) was an independent risk factor for the presence of acute confusional state on hospital admission (OR 2.98, 95% CI 1.04-8.50). However, ACB was not related to bone fractures on admission, length of stay, mortality or survival.

Conclusions: Patients with advanced chronic conditions are frequently treated with anticholinergic drugs, with excessive polypharmacy as a risk factor. Anticholinergic drugs are a risk factor for the presence of acute confusional state on hospital admission, but have no other effect in terms of morbimortality. Geriatr Gerontol Int 2018; 18: 1159-1165.

Keywords: Drug Burden Index; advanced chronic disease; anticholinergic burden; anticholinergic drug scale; end-of-life.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cholinergic Antagonists / adverse effects*
  • Cholinergic Antagonists / therapeutic use
  • Chronic Disease / drug therapy*
  • Chronic Disease / mortality
  • Cross-Sectional Studies
  • Drug-Related Side Effects and Adverse Reactions / etiology
  • Drug-Related Side Effects and Adverse Reactions / mortality*
  • Female
  • Geriatric Assessment / methods
  • Hospital Mortality*
  • Humans
  • Inappropriate Prescribing / statistics & numerical data
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Palliative Care / methods
  • Patient Admission / statistics & numerical data*
  • Polypharmacy
  • Prevalence
  • Prospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Spain
  • Survival Analysis


  • Cholinergic Antagonists