The effect of anticholinergic drug burden and number of drugs to nutritional status in older patients

Yıl 2020, , 209 - 217, 19.01.2021

Neziha Erken Esra Ateş Bulut , Süleyman Koçyiğit Ahmet Işık

https://doi.org/10.5505/deutfd.2020.29052

Öz

Objective: Malnutrition is an important cause of morbidity and mortality in older adults. In this study, it was aimed to investigate the relationship between malnutrition, a geriatric syndrome, and anticholinergic load as well as polypharmacy.
Materials and Methods: This study included 1287 patients who applied to the geriatrics clinic between 2016 and 2018. Demographic features, comorbidities and drugs of the patients were recorded. Nutritional status was evaluated with the Mini Nutritional Assessment-Short Form (MNA-SF). Accordingly, patients were divided into three groups in terms of nutritional status: malnutrition, risk of malnutrition and normal. The groups were compared according to polypharmacy. Anticholinergic load was calculated using the Drug Burden Index and the risk was compared between three groups.
Results: The mean age of the patients was 76.49 ± 7.35 and 65.6% of patients were women. According to the nutritional status, 8.6%, 31.0% and 60.4% were malnutrition, malnutrition-risk and normal nutritional group, respectively. Polypharmacy was accepted as concomittant use of more than four drugs. Age, Charlson Comorbidity Index, polypharmacy and DBI score were significantly different among nutritional groups (p <0.05). In the regression analysis, it was found that both DBI score and the number of drugs had a significant negative effect on the MNA-SF score, and the DBI score had a greater impact on the MNA-SF (p <0.05).
Conclusion: Polypharmacy and anticholinergic load are closely related to nutritional status in older adults. In geriatric practice, drug profiles should be evaluated precisely in the patients who have malnutrition or risk of malnutrition, and the required interventions should be implicated.

Anahtar Kelimeler

malnutrition, polypharmacy, elderly, drug effects, cholinergic antagonists

Antikolinerjik ilaç yükü ve ilaç sayısının yaşlı hastalarda beslenme durumuna etkisi

Öz

Amaç: Malnutrisyon yaşlı bireylerde önemli bir morbidite ve mortalite nedenidir. Bu çalışmada geriatrik sendromlardan malnutrisyonun, kolinerjik yük ve polifarmasi ile ilişkisini incelemek amaçlandı.
Gereç ve Yöntem: Çalışmaya 2016-2018 yılları arasında geriatri kliniğine başvuran 1287 hasta dâhil edildi. Hastaların demografik özellikleri, sistemik hastalıkları ve ilaçları kaydedildi. Nutrisyonel durum, Mini Nutrisyonel Değerlendirme Testi-Kısa Form (MNA-SF) ile değerlendirildi. Buna göre hastalar; malnutrisyon, malnutrisyon riski ve normal olarak üç gruba ayrıldı. Polifarmasi, aynı anda dörtten fazla ilaç kullanımı olarak kabul edildi. Antikolinerjik yük, İlaç Yükü İndeksi (İYİ) kullanılarak hesaplandı ve hastaların nutrisyonel durumuyla polifarmasi ve İYİ skoru arasındaki ilişki değerlendirildi.
Bulgular: Hastaların yaş ortalaması 76,49±7,35 ve %65,6’si kadındı. Hastaların %8,6’sında malnutrisyon, %31,0’inde malnutrisyon-riski olduğu görüldü. Nutrisyon grupları arasında yaş, Charlson Komorbidite İndeksi, polifarmasi ve İYİ skorları anlamlı olarak farklıydı (p<0,05). Yapılan regresyon analizinde hem İYİ skorunun hem de ilaç sayısının, MNA-SF ile negatif ilişkili olduğu ve İYİ skorunun MNA-SF üzerinde etkisinin daha fazla olduğu görüldü (p<0,05).
Sonuç: Polifarmasi ve antikolinerjik yük nutrisyonel durumla yakından ilişkilidir. Geriatri pratiğinde malnutrisyon ve malnutrisyon riski olan bireylerde kullanılan ilaçlar özellikle gözden geçirilmeli ve bu açıdan gerekli müdahaleler yapılmalıdır.

Anahtar Kelimeler

malnütrisyon, polifarmasi, yaşlı, ilaç etkileri, kolinerjik antagonistler

Kaynakça

• Unutmaz GD, Soysal P, Tuven B, Isik AT. Costs of medication in older patients: before and after comprehensive geriatric assessment. Clin Interv Aging. 2018;13:607-13.
• Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition – An ESPEN Consensus Statement. Clin Nutr. 2015;34:335-40.
• Kocyigit SE, Soysal P, Ates Bulut E, Isik AT. Malnutrition and Malnutrition Risk Can Be Associated with Systolic Orthostatic Hypotension in Older Adults. J Nutr Health Aging. 2018;22:928-33.
• Ates Bulut E, Soysal P, Isik AT. Frequency and coincidence of geriatric syndromes according to age groups: single-center experience in Turkey between 2013 and 2017. Clin Interv Aging. 2018;13:1899-905.
• Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. 2010;5:207-16.
• Jyrkkä J, Mursu J, Enlund H, Lönnroos E. Polypharmacy and nutritional status in elderly people. Curr Opin Clin Nutr Metab Care. 2012;15:1-6.
• Kim J, Parish AL. Polypharmacy and Medication Management in Older Adults. Nurs Clin North Am. 2017;52:457-68.
• Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol. 2007;63:187-95.
• Feinberg M. The problems of anticholinergic adverse effects in older patients. Drugs Aging. 1993;3:335-48.
• Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-83.
• Durmaz B, Soysal P, Ellidokuz H, Isik AT. Validity and reliability of geriatric depression scale-15 (short form) in Turkish older adults. North Clin Istanb. 2018;5:216-20.
• Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56:M366-72.
• Urfer M, Elzi L, Dell-Kuster S, Bassetti S. Intervention to Improve Appropriate Prescribing and Reduce Polypharmacy in Elderly Patients Admitted to an Internal Medicine Unit. PLoS One. 2016;11:e0166359.
• Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167:781-7.
• George D, Mallery P. SPSS for Windows Step by Step: A Simple Study Guide and Reference, 17.0 Update: Allyn & Bacon, Inc.; 2009.
• Donini LM, Poggiogalle E, Morrone A, Scardella P, Piombo L, Neri B, et al. Agreement between different versions of MNA. J Nutr Health Aging. 2013;17:332-8.
• Ates Bulut E, Khoury R, Lee H, Grossberg GT. Eating disturbances in the elderly: A geriatric-psychiatric perspective. Nutrition and Healthy Aging. 2019;5:185-98.
• Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med. 2002;18:737-57.
• Kerstetter JE, Holthausen BA, Fitz PA. Malnutrition in the institutionalized older adult. J Am Diet Assoc. 1992;92(9):1109-16.
• Rauscher C. Malnutrition among the elderly. Can Fam Physician. 1993;39:1395-403.
• Al-Rasheed R, Alrasheedi R, Al Johani R, Alrashidi H, Almaimany B, Alshalawi B, et al. Malnutrition in elderly and its relation to depression. 2018;5:5.
• Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in Prescription Drug Use Among Adults in the United States From 1999-2012. Jama. 2015;314:1818-31.
• Corcoran C, Murphy C, Culligan EP, Walton J, Sleator RD. Malnutrition in the elderly. Sci Prog. 2019;102:171-80.
• Donini LM, Scardella P, Piombo L, Neri B, Asprino R, Proietti AR, et al. Malnutrition in elderly: social and economic determinants. J Nutr Health Aging. 2013;17:9-15.
• Taché SV, Sönnichsen A, Ashcroft DM. Prevalence of adverse drug events in ambulatory care: a systematic review. Ann Pharmacother. 2011;45:977-89.
• Péter S, Navis G, de Borst MH, von Schacky C, van Orten-Luiten ACB, Zhernakova A, et al. Public health relevance of drug-nutrition interactions. Eur J Nutr. 2017;56(Suppl 2):23-36.
• Laure DM, Bruno L, Anne B, M A. Analyse of Polypharmacy and its Consequences on Nutritional Status in Elderly People Living in Nursing Home in Auvergne. Int J Pharmacovigil. 2018:3:1-8.
• Griep MI, Mets TF, Collys K, Ponjaert-Kristoffersen I, Massart DL. Risk of malnutrition in retirement homes elderly persons measured by the "mini-nutritional assessment". J Gerontol A Biol Sci Med Sci. 2000;55:M57-63.
• Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf. 2011;20:514-22.
• Moore TJ, Cohen MR, Furberg CD. Serious adverse drug events reported to the Food and Drug Administration, 1998-2005. Arch Intern Med. 2007;167:1752-9.
• Ali-Melkkilä T, Kanto J, Iisalo E. Pharmacokinetics and related pharmacodynamics of anticholinergic drugs. Acta Anaesthesiol Scand. 1993;37:633-42.
• Cao YJ, Mager DE, Simonsick EM, Hilmer SN, Ling SM, Windham BG, et al. Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clin Pharmacol Ther. 2008;83:422-9.
• Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006;46:1481-6.
• Lim R, Kalisch Ellett LM, Widagdo IS, Pratt NL, Roughead EE. Analysis of anticholinergic and sedative medicine effects on physical function, cognitive function, appetite and frailty: a cross-sectional study in Australia. BMJ Open. 2019;9:e029221.
• Gnjidic D, Le Couteur DG, Abernethy DR, Hilmer SN. Drug burden index and beers criteria: impact on functional outcomes in older people living in self-care retirement villages. J Clin Pharmacol. 2012;52:258-65.
• Hilmer SN, Mager DE, Simonsick EM, Ling SM, Windham BG, Harris TB, et al. Drug burden index score and functional decline in older people. Am J Med. 2009;122:1142-9.e1-2.
• Bollwein J, Volkert D, Diekmann R, Kaiser MJ, Uter W, Vidal K, et al. Nutritional status according to the mini nutritional assessment (MNA®) and frailty in community dwelling older persons: a close relationship. J Nutr Health Aging. 2013;17:351-6.
• Dent E, Visvanathan R, Piantadosi C, Chapman I. Use of the Mini Nutritional Assessment to detect frailty in hospitalised older people. J Nutr Health Aging. 2012;16:764-7.