AI Article Synopsis
- Polypharmacy, particularly the anticholinergic burden from medications, increases the risk of delirium in older patients due to changes in their cholinergic system.
- A prospective study of 421 patients evaluated preoperative medications and found that certain drug categories, including antidepressants and Parkinson's medication, significantly raised delirium risk, with a notable correlation to anticholinergic burden.
- The study emphasizes the importance of standardized medication documentation and suggests integrating the anticholinergic burden score into preoperative geriatric assessments to better identify patients at risk for delirium.
Article Abstract
Purpose: Polypharmacy is a widespread phenomenon in older patients. In particular, the anticholinergic burden of medication is an important risk factor for delirium due to age-related changes in the cholinergic system.
Methods: Preoperative medication, including the calculation of the anticholinergic burden (ACB), was recorded in a prospective study (421 patients) to identify potential risks associated with medication intake. Postoperative delirium screening was carried out daily.
Results: The study included 199 women (47.3%) and 222 men (52.7%) aged 80.8 ± 6.7 years and 78.8 ± 6.2 years, respectively. Antidepressants odds ratio (OR) 3.16 (95% confidence interval. CI, 1.51-6.64), antidiabetic drugs OR 2.53 (95% CI 1.27-5.03), neuroleptics OR 3.52 (95% CI 1.70-7.28) and Parkinson medication OR 5.88 (95% CI 1.95-17.7) showed a significantly higher risk for delirium. The ACB score revealed an anticholinergic burden in 43 patients (10.4%). The delirium rate was 25.6% (n = 11) and 11.0% (n = 40) had no anticholinergic burden. A significant correlation can be demonstrated with χ(1) = 7.52, p = 0.006, Cramer's V = 0.136. There was a 2.79-fold higher risk of delirium (OR 2.79, 95% CI 1.31-5.97).
Conclusion: The standardized recording of medication is essential, especially when identifying patients at risk of suffering from delirium. The use of the ACB score to assess the anticholinergic burden is a simple and reliable screening tool and should be part of a preoperative geriatric assessment.
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