The Association between Anticholinergic Drug Use and Rehabilitation Outcome in Post-Acute Hip Fractured Patients: A Retrospective Cohort Study
Anticholinergic (AC) drugs are associated with significant impairment in cognitive and physical function which may affect rehabilitation in older people. We aimed to evaluate whether AC burden is associated with rehabilitation achievement in post-acute hip-fractured patients.
A retrospective cohort study carried out in a post-acute geriatric rehabilitation center on 1019 hip-fractured patients admitted from January 2011 to October 2015. The Anticholinergic Cognitive Burden Scale (ACB) was used to quantify the AC burden. Main outcome measures included the Functional Independence Measure (FIM) instrument, motor FIM (mFIM), Montebello Rehabilitation Factor Score (MRFS) on the mFIM, and length of stay (LOS). The study population was divided into two groups: individuals with low admission AC burden (ACB ≤ 1) and those with high admission AC burden (ACB ≥ 2). The relationship between the admission AC burden and clinical, demographic and comorbidity variables was assessed using the Mann–Whitney and Chi square tests. A multiple linear regression model was used to estimate the association between admission AC burden and discharge FIM score after controlling for sociodemographic characteristics and chronic diseases.
Patients with a high admission AC burden had a significantly higher rate of high education, a significantly lower rate reside at home, they waited a longer period of time from surgery to rehabilitation, were less independent pre-fracture, and presented with a higher rate of vascular disorders and depression compared with patients with a lower admission AC burden. These patients also exhibited a significantly lower FIM score on admission and at discharge, a lower FIM score change, and a lower achievement on the MRFS compared with patients with a lower admission AC burden. A multiple linear regression analysis showed that admission AC burden was significantly associated with the discharge FIM score after adjustment for confounding variables.
High admission AC drug burden is significantly associated with less favorable discharge functional status in post-acute hip-fractured patients, independent of relevant risk factors.
The authors would like to thank Mrs. Phyllis Curchack Kornspan for her editorial services, and Ilana Gilarentel (Tel Aviv University) for her statistical support.
Avital Hershkovitz initiated the study, helped write the manuscript, and was involved in data collection and review of the literature. Corina Angel was involved with data collection and helped review the literature. Shai Brill assisted in editing the manuscript and reviewing the literature. Ran Nissan helped write the manuscript and review the literature, and was involved in data collection.
Compliance with Ethical Standards
Conflicts of interest
Avital Hershkovitz, Corina Angel (deceased), Shai Brill, and Ran Nissan have no conflicts of interest relevant to the content of this study.
The ‘Beit Rivka’ Geriatric Medical Center Institutional Review Board (#7388) approved this study.
No sources of funding were used to assist in the conduct of this study.
- 13.Pasina L, Djade CD, Lucca U, et al. Association of anticholinergic burden with cognitive and functional status in a cohort of hospitalized elderly: comparison of the anticholinergic cognitive burden scale and anticholinergic risk scale: results from the REPOSI study. Drugs Aging. 2013;30:103–12.CrossRefPubMedGoogle Scholar
- 15.Hamilton BB, Granger CV, Sherwin FS, et al. A uniform national data system for medical rehabilitation. In: Fuhrer MJ, editor. Rehabilitation outcomes: analysis and measurement. Buffalo: Brookes Publishing Co.; 1987. p. 137–47.Google Scholar
- 21.http://www.agingbraincare.org/uploads/products/ACB_scale-legal_size.pdf. Accessed 10 Feb 2018.