Anticholinergic Load and Nutritional Status in Older Individuals

  • Eiji KoseEmail author
  • T. Hirai
  • T. Seki
  • N. Yasuno



The association between anticholinergic load-based Anticholinergic Risk Scale scores and nutritional status is unclear in Japanese patients. The aim of this study was to establish whether anticholinergic load affects the nutritional status of geriatric patients in convalescent stages.


Retrospective longitudinal cohort study.


Convalescent rehabilitation wards.


Of the 1490 patients aged ≥65 years who were discharged from convalescent rehabilitation wards between July 2010 and October 2018, 908 patients met the eligibility criteria. They were categorized according to the presence or absence of increased anticholinergic load from admission to discharge.


Demographic data, laboratory data, the Functional Independence Measure were analyzed between the groups. The primary outcome was Geriatric Nutritional Risk Index (GNRI) at discharge. Multiple linear regression analysis was performed to analyze the relationship between anticholinergic load and GNRI at discharge.


Multiple linear regression analysis after adjusting for confounding factors revealed that anticholinergic load was independently and negatively correlated with GNRI at discharge. Particularly, the use of chlorpromazine, hydroxyzine, haloperidol, metoclopramide, risperidone, etc. increased significantly from admission to discharge.


Increased anticholinergic load during hospitalization may be a predictor of nutritional status in geriatric patients.

Key words

Anticholinergic drug anticholinergic risk scale geriatric nutritional risk index older individuals 



The authors thank the manager of Hitachinaka Gereral Hospital who agreed for this study to take place.

Conflict of interest: The authors declare that there is no conflict of interest regarding the publication of this article.


  1. 1.
    Kaiser MJ, Bauer JM, Rämsch C, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010; 58(9): 1734–38.CrossRefGoogle Scholar
  2. 2.
    Schrader E, Baumgärtel C, Gueldenzoph H, et al. Nutritional status according to Mini Nutritional Assessment is related to functional status in geriatric patients—independent of health status. J Nutr Health Aging. 2014; 18(3): 257–63.CrossRefGoogle Scholar
  3. 3.
    van Bokhorst-de van der Schueren MA, Lonterman-Monasch S, de Vries OJ, Danner SA, Kramer MH, Muller M. Prevalence and determinants for malnutrition in geriatric outpatients. Clin Nutr. 2013; 32(6): 1007–11.CrossRefGoogle Scholar
  4. 4.
    Marshall S, Young A, Bauer J, Isenring E. Malnutrition in Geriatric Rehabilitation: Prevalence, Patient Outcomes, and Criterion Validity of the Scored Patient-Generated Subjective Global Assessment and the Mini Nutritional Assessment. J Acad Nutr Diet. 2016; 116(5): 785–94.CrossRefGoogle Scholar
  5. 5.
    Antonelli Incalzi R, Landi F, Cipriani L, et al. Nutritional assessment: a primary component of multidimensional geriatric assessment in the acute care setting. J Am Geriatr Soc. 1996; 44(2): 166–74.CrossRefGoogle Scholar
  6. 6.
    Zuliani G, Romagnoni F, Soattin L, Leoci V, Volpato S, Fellin R. Predictors of two-year mortality in older nursing home residents. The IRA study. Istituto di Riposo per Anziani. Aging (Milano). 2001; 13(1): 3–7.Google Scholar
  7. 7.
    Kalm LM, Semba RD. They starved so that others be better fed: remembering Ancel Keys and the Minnesota experiment. J Nutr. 2005; 135(6): 1347–52.CrossRefGoogle Scholar
  8. 8.
    Jensen GL, Mirtallo J, Compher C, et al. Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. J Parenter Enteral Nutr. 2010; 34(2): 156–9.CrossRefGoogle Scholar
  9. 9.
    Blazer DG 2nd, Federspiel CF, Ray WA, Schaffner W. The risk of anticholinergic toxicity in the elderly: a study of prescribing practices in two populations. J Gerontol. 1983; 38(1): 31–5.CrossRefGoogle Scholar
  10. 10.
    Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008; 168(5): 508–13.CrossRefGoogle Scholar
  11. 11.
    Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil. 1996; 77(12): 1226–32.CrossRefGoogle Scholar
  12. 12.
    Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005; 86(8): 1516–20.CrossRefGoogle Scholar
  13. 13.
    Bouillanne O, Morineau G, Dupont C et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005; 82(4): 777–83.CrossRefGoogle Scholar
  14. 14.
    Cereda E, Vanotti A. The new geriatric nutritional risk index is a good predictor of muscle dysfunction in institutionalized older patients. Clin Nutr. 2007; 26(1): 78–83.CrossRefGoogle Scholar
  15. 15.
    Yamada K, Furuya R, Takita T et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr. 2008; 87(1): 106–13.CrossRefGoogle Scholar
  16. 16.
    Shah B, Sucher K, Hollenbeck CB. Comparison of ideal body weight equations and published height-weight tables with body mass index tables for healthy adults in the United States. Nutr Clin Pract. 2006; 21(3): 312–9.CrossRefGoogle Scholar
  17. 17.
    Kinugasa Y, Kato M, Sugihara S et al. Geriatric nutritional risk index predicts functional dependency and mortality in patients with heart failure with preserved ejection fraction. Circ J. 2013; 77(3): 705–11.CrossRefGoogle Scholar
  18. 18.
    Kose E, Hirai T, Seki T, Hayashi H. Role of potentially inappropriate medication use in rehabilitation outcomes for geriatric patients after strokes. Geriatr Gerontol Int. 2018; 18(2): 321–8.CrossRefGoogle Scholar
  19. 19.
    Cummings JL. Behavioral complications of drug treatment of Parkinson’s disease. J Am Geriatr Soc. 1991; 39(7): 708–16.CrossRefGoogle Scholar
  20. 20.
    Bédard MA, Pillon B, Dubois B, Duchesne N, Masson H, Agid Y. Acute and long-term administration of anticholinergics in Parkinson’s disease: specific effects on the subcortico-frontal syndrome. Brain Cogn. 1999; 40(2): 289–313.CrossRefGoogle Scholar
  21. 21.
    Guérin O, Andrieu S, Schneider SM, et al. Different modes of weight loss in Alzheimer disease: a prospective study of 395 patients. Am J Clin Nutr. 2005; 82(2): 435–41.CrossRefGoogle Scholar
  22. 22.
    Perry E, Walker M, Grace J, Perry R. Acetylcholine in mind: a neurotransmitter correlate of consciousness? Trends Neurosci. 1999; 22(6): 273–80.CrossRefGoogle Scholar
  23. 23.
    Gray SL, Anderson ML, Dublin S et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015; 175(3): 401–7.CrossRefGoogle Scholar
  24. 24.
    Walston J, Hadley EC, Ferrucci L et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society / National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006; 54(6): 991–1001.CrossRefGoogle Scholar
  25. 25.
    National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006; 54(6): 508–13.Google Scholar
  26. 26.
    Cederholm T, Bosaeus I, Barazzoni R et al. Diagnostic criteria for malnutrition - an ESPEN consensus statement. Clin Nutr. 2015; 34(3): 335–40.CrossRefGoogle Scholar
  27. 27.
    Durán CE, Azermai M, Vander Stichele R. Systematic review of anticholinergic risk scales in older adults. Response to letter of the editor. Eur J Clin Pharmacol. 2013; 69(9): 1731.CrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag International SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PharmacyTeikyo University School of Medicine University HospitalTokyoJapan
  2. 2.Department of PharmacyHitachinaka General HospitalIbarakiJapan
  3. 3.Laboratory of Hospital Pharmacy, School of PharmacyTeikyo UniversityTokyoJapan

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