OBJECTIVES Anticholinergic drugs have several side effects, and they have been associated with adverse outcomes, particularly in older patients. The aim of this study was to analyze anticholinergic burden and its relationship to delirium and mortality in older acutely ill medical patients. DESIGN Cohort study. SETTING AND PARTICIPANTS Patients 65 years of age and older who were admitted to an Internal Medicine ward between August 1 and December 31, 2016. METHODS Anticholinergic drug use, outpatient and inpatient, was assessed using the Anticholinergic Cognitive Burden Scale (ACB). Prevalent delirium was diagnosed by the Short Confusion Assessment Method (Short-CAM). RESULTS Of the 198 patients, 28.3% developed delirium. Mortality rate was 13.6% in-hospital and 45.6% at 12 months. In multivariate analysis, outpatient ACB was associated with delirium, with an odds ratio (OR) of 1.65 [95% confidence interval (CI) 1.09-2.51]. Those with delirium had longer hospital stays (median 13 vs 8 days; P = .01), received more drugs (median 18 vs 15; P = .02), and presented a higher inpatient ACB (mean 3.9 vs 3.1; P = .034). No increased risk was found for in-hospital or 12-month mortality with drug use, ACB, or delirium. DISCUSSION In the population studied, we found an association between anticholinergic burden as measured by the ACB and the presence of delirium, but not with mortality at 12 months. A very high 12-month mortality rate might have been an obstacle for association recognition. CONCLUSIONS AND IMPLICATIONS Clinician awareness of possible drug side effects, especially in older populations, is crucial. As part of medication reconciliation at the time of hospitalization, ACB of prehospitalization medications should be routinely calculated by inpatient pharmacy services and made available to medical teams.

中文翻译：

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院前抗胆碱能负荷与谵妄有关，但与急性内科患者的死亡率无关

目的 抗胆碱能药物有多种副作用，并且与不良结局相关，尤其是在老年患者中。本研究的目的是分析老年急性内科患者的抗胆碱能负担及其与谵妄和死亡率的关系。设计队列研究。地点和参与者 2016 年 8 月 1 日至 12 月 31 日期间入住内科病房的 65 岁及以上患者。 方法 使用抗胆碱能认知负担量表 (ACB) 评估门诊和住院患者的抗胆碱能药物使用情况。普遍的谵妄是通过短期混乱评估方法（Short-CAM）诊断出来的。结果 198 名患者中，28.3% 出现谵妄。住院死亡率为 13.6%，12 个月时为 45.6%。在多元分析中，门诊 ACB 与谵妄相关，优势比 (OR) 为 1.65 [95% 置信区间 (CI) 1.09-2.51]。谵妄患者住院时间更长（中位数 13 天 vs 8 天；P = .01），接受更多药物治疗（中位数 18 天 vs 15 天；P = .02），并且住院 ACB 较高（平均 3.9 天 vs 3.1 天；P = .01）。 034)。未发现吸毒、ACB 或谵妄会增加院内或 12 个月死亡率的风险。讨论 在研究的人群中，我们发现 ACB 测量的抗胆碱能负荷与谵妄的存在之间存在关联，但与 12 个月时的死亡率无关。非常高的 12 个月死亡率可能是协会识别的障碍。结论和意义 临床医生对可能的药物副作用的认识，尤其是在老年人群中，是至关重要的。