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.

中文翻译：

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手握力可能会影响出院的老年患者的抗胆碱能负担与死亡率之间的关系。

背景与目的抗胆碱能负担与死亡率之间的关系尚不清楚，而且抗胆碱能负担对预后的影响可能会因老年时常见的其他疾病而有所不同。我们旨在研究握力强度作为抗胆碱能负担与出院老年患者1年死亡率之间关联的潜在作用调节剂的作用。方法我们的研究由620名在前瞻性多中心观察性研究中连续入选7个老年和内科急诊病房的老年患者组成。通过抗胆碱能认知负担（ACB）评分评估总体抗胆碱能负担。握力强度是通过使用North Coast医用测功机进行评估的，并使用按性别划分的临界值（女性<15 kg，男子<20公斤）。研究结果为1年死亡率。通过Cox回归分析进行统计分析。结果在校正了潜在的混杂因素后，ACB分数等于或大于2且手握力低的同时出现与死亡率显着相关（危险比[HR] = 2.30，95％置信区间[CI] 1.07-6.01）。分层分析证实，ACB得分≥2与低（HR = 2.15，95％CI 1.08-5.02）患者的死亡率相关，但与正常握力无关（HR = 0.88，95％CI 0.13-3.52） 。在3个月的随访中调整ACB评分后（HR = 2.20； 95％CI 1.09-4.87），以及将ACB评分视为连续变量后，在具有低握力的患者中证实了相关性（HR = 1.24，95％CI 1.03-1.48）。结论出院时ACB评分可预测从手握强度低的急诊医院出院的老年患者的死亡率。医院医生应意识到，在这种脆弱人群中开抗胆碱药可能会对预后产生负面影响。