Skip to main content
SpringerLink
Log in

Anticholinergic Load and Nutritional Status in Older Individuals

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

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.

Design

Retrospective longitudinal cohort study.

Setting

Convalescent rehabilitation wards.

Participants

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.

Measurements

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.

Results

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.

Conclusion

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  19. Cummings JL. Behavioral complications of drug treatment of Parkinson’s disease. J Am Geriatr Soc. 1991; 39(7): 708–16.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  22. Perry E, Walker M, Grace J, Perry R. Acetylcholine in mind: a neurotransmitter correlate of consciousness? Trends Neurosci. 1999; 22(6): 273–80.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  25. National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006; 54(6): 508–13.

    Google Scholar 

  26. Cederholm T, Bosaeus I, Barazzoni R et al. Diagnostic criteria for malnutrition - an ESPEN consensus statement. Clin Nutr. 2015; 34(3): 335–40.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

Download references

Acknowledgement

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

Author information

Authors and Affiliations

  1. Department of Pharmacy, Teikyo University School of Medicine University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 274-8555, Japan

    Eiji Kose & N. Yasuno

  2. Department of Pharmacy, Hitachinaka General Hospital, Ibaraki, Japan

    T. Hirai & T. Seki

  3. Laboratory of Hospital Pharmacy, School of Pharmacy, Teikyo University, Tokyo, Japan

    N. Yasuno

Authors
  1. Eiji Kose
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Hirai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Seki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Yasuno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eiji Kose.

Ethics declarations

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kose, E., Hirai, T., Seki, T. et al. Anticholinergic Load and Nutritional Status in Older Individuals. J Nutr Health Aging 24, 20–27 (2020). https://doi.org/10.1007/s12603-019-1283-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-019-1283-x

Key words

Search

Navigation