Abstract
ObjectivesAnticholinergic burden defined by the Anticholinergic Risk Scale (ARS) has been associated with cognitive and functional decline. Associations with health-related quality of life (HRQoL) have been scarcely studied. The aim of this study was to examine the association between anticholinergic burden and HRQoL among older people living in long-term care. Further, we investigated whether there is an interaction between ARS score and HRQoL in certain underlying conditions.Design and participantsCross-sectional study in 2017. Participants were older people residing in long-term care facilities (N=2474) in Helsinki.MeasurementsData on anticholinergic burden was assessed by ARS score, nutritional status by Mini Nutritional Assessment, and HRQoL by the 15D instrument.ResultsOf the participants, 54% regularly used ARS-defined drugs, and 22% had ARS scores ≥2. Higher ARS scores were associated with better cognition, functioning, nutritional status and higher HRQoL. When viewing participants separately according to a diagnosis of dementia, nutritional status or level of dependency, HRQoL was lower among those having dementia, worse nutritional status, or being dependent on another person’s help (adjusted for age, sex, comorbidities). Significant differences within the groups according to ARS score were no longer observed. However, interactions between ARS score and dementia and dependency emerged.ConclusionIn primary analysis there was an association between ARS score and HRQoL. However, this relationship disappeared after stratification by dementia, nutritional status and dependency. The reasons behind the interaction concerning dementia or dependency remain unclear and warrant further studies.
Highlights
The participants were divided into four groups according to the Anticholinergic Risk Scale (ARS) score [G0 (n=1149); G1, (n=768); G2 (n=347); G3 (n=210)]
A greater ARS score was associated with younger age and a lower proportion of females
Among residents with dementia or dependency, the trend in health-related quality of life (HRQoL) scores increased with greater ARS score, whereas the trend was in the opposite direction among residents without dementia and those who were not dependent
Summary
Anticholinergic burden defined by the Anticholinergic Risk Scale (ARS) has been associated with cognitive and functional decline. The aim of this study was to examine the association between anticholinergic burden and HRQoL among older people living in long-term care. We investigated whether there is an interaction between ARS score and HRQoL in certain underlying conditions. Measurements: Data on anticholinergic burden was assessed by ARS score, nutritional status by Mini Nutritional Assessment, and HRQoL by the 15D instrument. Higher ARS scores were associated with better cognition, functioning, nutritional status and higher HRQoL. Interactions between ARS score and dementia and dependency emerged. Conclusion: In primary analysis there was an association between ARS score and HRQoL. This relationship disappeared after stratification by dementia, nutritional status and dependency. The reasons behind the interaction concerning dementia or dependency remain unclear and warrant further studies
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