¹Virginia Commonwealth University, University Health System Consortium, Richmond, VA

Abstract

Background/aims: Anticholinergic (ACh) use is common among hospitalized elderly patients and is associated with increased length of stay (LOS). The purpose of this analysis was to further evaluate the relationship between ACh use and LOS in hospitalized elderly patients with and without dementia.

Methods: This retrospective database analysis, from 42 U.S. hospitals participating in University HealthSystem Consortium's Clinical Database-Pharmacy, from Oct 2003 to Sept 2004, included patients who either did (n = 12,481) or did not (n = 210,103) have dementia. Multiple regression showed a significant association between LOS and patient severity, discharge status and use of an ACh drug in both groups. Secondary regression analyses were conducted using a continuous measure of ACh burden (calculated as a component of dose, potency, and days of therapy) for patients receiving ACh drugs in each group. Rate of delirium and ratio of observed LOS to expected LOS (from regression models not considering drug use) was compared in patients who did and did not receive ACh drugs for each group.

Results: Increased ACh burden was associated with increased LOS in both groups. The rate of delirium and the LOSobs/LOSexp were significantly higher (p<0.05) in patients taking ACh drugs in both groups.

Conclusions: These findings add validity to the observed association between increased LOS and ACh drug use in hospitalized elderly patients. Increased attention to this issue is needed.