Impact of anticholinergic burden on emergency department visits among older adults in Korea: A national population cohort study

Abstract

Objectives: This study aimed to evaluate the impact of high anticholinergic burden on overall emergency department (ED) visits and ED visits related to adverse effects of anticholinergic drugs among older adults. Methods: For this retrospective cohort study, we used claims data from older adults with high representativeness. The average daily Anticholinergic Risk Scale (ARS) score was calculated based on the dosage, treatment duration, and potency of anticholinergic drugs during three months. A high-exposure group (ARS >= 2) and a non-exposure group were included in this analysis. The primary outcome was the first ED visit during the follow-up period. Anticholinergic ED visits were defined as ED visits with a main diagnosis of a fall, fracture, dizziness, delirium, constipation, or urinary retention. Results: In total, 118,750 subjects (43.6% male) were included in this study. The mean age was 75.4 +/- 6.6 years. The adjusted hazard ratios (aHRs) for all-cause and anticholinergic ED visits among those with high ARS scores were 1.28 (95% CI: 1.20-1.36) and 1.55 (95% CI: 1.38-1.74), respectively. The high-exposure group was at higher risk than the non-exposure group for ED visits for falls or fractures (aHR: 1.31, 95% CI: 1.07-1.60), dizziness (aHR: 1.71, 95% CI: 1.36-2.14), delirium (aHR: 2.05, 95% CI: 1.13-3.73), constipation (aHR: 1.65, 95% CI: 1.35-2.02) and urinary retention (aHR: 1.66, 95% CI: 1.30-2.12). Conclusions: This study demonstrated that a high anticholinergic burden in older adults increased the risk of all-cause ED visits, anticholinergic ED visits and specific-cause ED visits.