Anticholinergic burden and poor oral health are associated with frailty in geriatric patients undergoing inpatient rehabilitation: A cross-sectional study.
anticholinergic medications
frailty
oral health
Journal
Gerodontology
ISSN: 1741-2358
Titre abrégé: Gerodontology
Pays: England
ID NLM: 8215850
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
03
03
2022
accepted:
07
04
2022
medline:
19
5
2023
pubmed:
29
4
2022
entrez:
28
4
2022
Statut:
ppublish
Résumé
Poor oral health is known to be associated with frailty in geriatric populations. Recent exposure to anticholinergic medications is responsible for features of poor oral health. Anticholinergic medications pose a cumulative risk for frailty. We studied 115 geriatric inpatients (aged >65 years and recruited over a 3-month period from October to December 2017). Patients who were severely agitated, cognitively impaired, from a non-English speaking background and with severe sensory impairment were excluded. Frailty and oral health were assessed using the Reported Edmonton Frailty Scale and the Oral Health Assessment Test, respectively. Exposure to anticholinergic medications was assessed using the Anticholinergic Burden Scale. The mean age was 80 (range from 66 to 101). Only 44 patients (38.3%) were not exposed to any anticholinergic medication. Nearly two-thirds of patients were taking anticholinergic medications, with 25% classified as having a high anticholinergic burden (ACB ≥ 4). Approximately one-third of severely frail patients were exposed to a high anticholinergic burden. Patients with a high anticholinergic burden were more than twice as likely to have severe frailty (OR 2.21; 95% confidence interval 1.05-4.6). Poor oral health was associated with frailty (OR 1.24; 95% CI 1.02-1.49). High anticholinergic burden was found to be a risk marker for severe frailty independent of its effect on oral health. Poor oral health was associated with all levels of frailty. This study highlights a need for a review of medications with anticholinergic properties in older patients. Further research should be directed at whether deprescribing could prevent poor oral health or slow the progression of frailty.
Sections du résumé
BACKGROUND
BACKGROUND
Poor oral health is known to be associated with frailty in geriatric populations. Recent exposure to anticholinergic medications is responsible for features of poor oral health. Anticholinergic medications pose a cumulative risk for frailty.
METHODS
METHODS
We studied 115 geriatric inpatients (aged >65 years and recruited over a 3-month period from October to December 2017). Patients who were severely agitated, cognitively impaired, from a non-English speaking background and with severe sensory impairment were excluded. Frailty and oral health were assessed using the Reported Edmonton Frailty Scale and the Oral Health Assessment Test, respectively. Exposure to anticholinergic medications was assessed using the Anticholinergic Burden Scale.
RESULTS
RESULTS
The mean age was 80 (range from 66 to 101). Only 44 patients (38.3%) were not exposed to any anticholinergic medication. Nearly two-thirds of patients were taking anticholinergic medications, with 25% classified as having a high anticholinergic burden (ACB ≥ 4). Approximately one-third of severely frail patients were exposed to a high anticholinergic burden. Patients with a high anticholinergic burden were more than twice as likely to have severe frailty (OR 2.21; 95% confidence interval 1.05-4.6). Poor oral health was associated with frailty (OR 1.24; 95% CI 1.02-1.49).
CONCLUSION
CONCLUSIONS
High anticholinergic burden was found to be a risk marker for severe frailty independent of its effect on oral health. Poor oral health was associated with all levels of frailty. This study highlights a need for a review of medications with anticholinergic properties in older patients. Further research should be directed at whether deprescribing could prevent poor oral health or slow the progression of frailty.
Substances chimiques
Cholinergic Antagonists
0
Types de publication
Review
Journal Article
Langues
eng
Pagination
213-219Informations de copyright
© 2022 Gerodontology Association and John Wiley & Sons Ltd.
Références
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156.
Artaza-Artabe I, Saez-Lopez P, Sanchez-Hernandez N, Fernandez-Gutierrez N, Malafarina V. The relationship between nutrition and frailty: effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly. A systematic review. Maturitas. 2016;93:89-99.
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752-762.
Castrejon-Perez RC, Borges-Yanez SA, Gutierrez-Robledo LM, Avila-Funes JA. Oral health conditions and frailty in Mexican community-dwelling elderly: a cross sectional analysis. BMC Public Health. 2012;12:773.
Castrejon-Perez RC, Borges-Yanez SA. Frailty from an Oral health point of view. J Frailty Aging. 2014;3(3):180-186.
Zia A, Kamaruzzaman S, Myint PK, Tan MP. Anticholinergic burden is associated with recurrent and injurious falls in older individuals. Maturitas. 2016;84:32-37.
Kshetrimayum N, Reddy CV, Siddhana S, Manjunath M, Rudraswamy S, Sulavai S. Oral health-related quality of life and nutritional status of institutionalized elderly population aged 60 years and above in Mysore City, India. Gerodontology. 2013;30(2):119-125.
Gil-Montoya JA, Subira C, Ramon JM, Gonzalez-Moles MA. Oral health-related quality of life and nutritional status. J Public Health Dent. 2008;68(2):88-93.
de Andrade FB, Lebrao ML, Santos JL, Duarte YA. Relationship between oral health and frailty in community-dwelling elderly individuals in Brazil. J Am Geriatr Soc. 2013;61(5):809-814.
Shwe PS, Ward SA, Thein PM, Junckerstorff R. Frailty, oral health and nutrition in geriatrics inpatients: a cross-sectional study. Gerodontology. 2019;36(3):223-228.
Hoeksema AR, Peters LL, Raghoebar GM, Meijer HJA, Vissink A, Visser A. Oral health status and need for oral care of care-dependent indwelling elderly: from admission to death. Clin Oral Investig. 2017;21(7):2189-2196.
Watanabe Y, Hirano H, Arai H, et al. Relationship between frailty and Oral function in community-dwelling elderly adults. J Am Geriatr Soc. 2017;65(1):66-76.
Miura H, Yamasaki K, Morizaki N, Moriya S, Sumi Y. Factors influencing oral health-related quality of life (OHRQoL) among the frail elderly residing in the community with their family. Arch Gerontol Geriatr. 2010;51(3):e62-e65.
Ewan V, Newton JL, Rushton S, Walls AW. Oral hygiene of hospitalised older patients with lower limb fracture. Age Ageing. 2016;45(6):887-890.
Tiisanoja A, Syrjala AM, Komulainen K, et al. Anticholinergic burden and dry mouth among Finnish, community-dwelling older adults. Gerodontology. 2018;35(1):3-10.
Villalba-Moreno AM, Alfaro-Lara ER, Perez-Guerrero MC, Nieto-Martin MD, Santos-Ramos B. Systematic review on the use of anticholinergic scales in poly pathological patients. Arch Gerontol Geriatr. 2016;62:1-8.
Landi F, Dell’Aquila G, Collamati A, et al. Anticholinergic drug use and negative outcomes among the frail elderly population living in a nursing home. J Am Med Dir Assoc. 2014;15(11):825-829.
Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The anticholinergic drug scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006;46(12):1481-1486.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383.
Salahudeen MS, Hilmer SN, Nishtala PS. Comparison of anticholinergic risk scales and associations with adverse health outcomes in older people. J Am Geriatr Soc. 2015;63(1):85-90.
Tune LE, Egeli S. Acetylcholine and delirium. Dement Geriatr Cogn Disord. 1999;10(5):342-344.
Gnjidic D, Hilmer SN, Hartikainen S, et al. Impact of high risk drug use on hospitalization and mortality in older people with and without Alzheimer’s disease: a national population cohort study. PLoS One. 2014;9(1):e83224.
Uusvaara J, Pitkala KH, Kautiainen H, Tilvis RS, Strandberg TE. Association of anticholinergic drugs with hospitalization and mortality among older cardiovascular patients: a prospective study. Drugs Aging. 2011;28(2):131-138.
Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc. 2011;59(8):1477-1483.
Chalmers JM, King PL, Spencer AJ, Wright FA, Carter KD. The Oral health assessment tool-validity and reliability. Aust Dent J. 2005;50(3):191-199.
Kayser-Jones J, Bird WF, Paul SM, Long L, Schell ES. An instrument to assess the oral health status of nursing home residents. Gerontologist. 1995;35(6):814-824.
Ruiz SJ, Cevallos V, Baskaran D, Mintzer MJ, Ruiz JG. The cross-sectional association of frailty with past and current exposure to strong anticholinergic drugs. Aging Clin Exp Res. 2021;33(8):2283-2289.
Petty DR, House A, Knapp P, Raynor T, Zermansky A. Vailidity and reliability of reported Edmonton frailty scale (REFS). Age Ageing. 2006;35(5):526-529.
Lampela P, Taipale H, Hartikainen S. Association between anticholinergic load and frailty in community-dwelling older people. J Am Geriatr Soc. 2016;64(3):671-672.
Moulis F, Moulis G, Balardy L, et al. Exposure to atropinic drugs and frailty status. J Am Med Dir Assoc. 2015;16(3):253-257.