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Hand Grip Strength May Affect the Association Between Anticholinergic Burden and Mortality Among Older Patients Discharged from Hospital

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Abstract

Background and Objective

The relationship between anticholinergic burden and mortality is unclear, and the impact of anticholinergic burden on prognosis may vary in the presence of other conditions common in old age. We aimed to investigate the role of hand grip strength as a potential effect modifier in the association between anticholinergic burden and 1-year mortality in older patients discharged from hospital.

Methods

Our series consisted of 620 older patients consecutively admitted to seven geriatric and internal medicine acute care wards in the context of a prospective multicenter observational study. Overall anticholinergic burden was assessed by Anticholinergic Cognitive Burden (ACB) score. Hand grip strength was assessed by the use of a North Coast medical hand dynamometer and categorized by using sex-specific cut-offs (women < 15 kg, men < 20 kg). The study outcome was 1-year mortality. Statistical analysis was performed by Cox regression analysis.

Results

After adjusting for potential confounders, the co-occurrence of an ACB score of 2 or more and low hand grip strength was significantly associated with mortality (hazard ratio [HR] = 2.30, 95% confidence interval [CI] 1.07–6.01). Stratified analysis confirmed that an ACB score of 2 or more was associated with mortality among patients with low (HR = 2.15, 95% CI 1.08–5.02), but not normal hand grip strength (HR = 0.88, 95% CI 0.13–3.52). The association was confirmed among patients with low hand grip strength after adjusting for the ACB score at the 3-month follow-up (HR = 2.20; 95% CI 1.09–4.87), as well as when considering the ACB score as a continuous variable (HR = 1.24, 95% CI 1.03–1.48).

Conclusions

The ACB score at discharge may predict mortality among older patients discharged from an acute care hospital with low hand grip strength. Hospital physicians should be aware that prescribing anticholinergic medications in such a vulnerable population may have negative prognostic implications.

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Author information

Authors and Affiliations

  1. Unit of Geriatric Pharmacoepidemiology and Biostatistics, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy

    Sonia D’Alia, Francesco Guarasci, Andrea Corsonello & Paolo Fabbietti

  2. Unit of Geriatric Medicine, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona and Cosenza, Italy

    Luca Bartucci, Ramona Caloiero, Maurizio Leonardo Guerrieri & Andrea Corsonello

  3. Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy

    Luca Soraci

  4. Unit of Rehabilitative Pneumology, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Casatenovo, Italy

    Daniele Colombo

  5. Clinical Laboratory, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy

    Lucia Crescibene

  6. Department of Cardiovascular and Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy

    Graziano Onder

  7. Department of Medical Sciences, University of Ferrara, Ferrara, Italy

    Stefano Volpato

  8. Geriatrics and Geriatric Emergency Care, IRCCS INRCA, Ancona, Italy

    Antonio Cherubini

  9. Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy

    Carmelinda Ruggiero

  10. Scientific Direction, Scientific Research Institute-Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy

    Fabrizia Lattanzio

Authors
  1. Sonia D’Alia
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Corresponding author

Correspondence to Francesco Guarasci.

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Funding

The CRiteria to assess Inappropriate Medication use among Elderly complex patients (CRIME) project was partially supported by a grant from the Italian Ministry of Health (GR-2007 685638).

Conflict of interest

D’Alia Sonia, Guarasci Francesco, Bartucci Luca, Caloiero Ramona, Guerrieri Maurizio Leonardo, Soraci Luca, Colombo Daniele, Crescibene Lucia, Onder Graziano, Volpato Stefano, Cherubini Antonio, Ruggiero Carmelinda, Corsonello Andrea, Lattanzio Fabrizia, and Fabbietti Paolo have no conflicts of interest that are directly relevant to the content of this article.

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All ethics committees at participating institutions approved the study in accordance with the Declaration of Helsinki.

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Written informed consent was obtained from all participants.

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D’Alia, S., Guarasci, F., Bartucci, L. et al. Hand Grip Strength May Affect the Association Between Anticholinergic Burden and Mortality Among Older Patients Discharged from Hospital. Drugs Aging 37, 447–455 (2020). https://doi.org/10.1007/s40266-020-00766-x

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