The effect of polypharmcy and anticholinergic burden on nutritional parameters in older adults

Introduction and Aim: Decrease in appetite, dysphagia and malnutrition are common in older patients and are associated with many complications. Anticholinergic drugs can adversely affect nutritional parameters with side effects such as dry mouth, constipation and deterioration in cognitive functions, and these drugs are used more frequently in patients with dementia. Therefore, in this study, the effect of high anticholinergic drug burden (ADB) on dysphagia and nutritional status in older patients with and without dementia is investigated. Materials and Methods: : 1165 (31.6% dementia) older patients admitted to the geriatric clinic were included. Age, gender, education level, comorbid diseases, drugs used and number of drug used; basic and instrumental activities of daily living (BADL, IADL) and cognitive functions were evaluated. ACB scale was used for anticholinergic drug load; those with an ACB score of ≥2 were considered high ADB. In interviews with patients and their caregivers, Mini- Nutritional-Assessment (17-23.5/30 and <17/30, malnutrition risk and malnutrition, respectively) for nutritional status and Eating Assessment Tool score-10 scale (≥3 /10, dysphagia) for dysphagia were applied to all patients. The Council on Nutrition Appetite Questionnaire (≤ 28/40, loss of appetite) was only applicable to patients without dementia. Results: 44.5% of dementia patients had high ADB. After adjustment for the effects of age, Parkinson's disease (PD), heart failure (HF), BADL and IADL scores, which were the variables that found different between those with high ADB and those with low ADB; malnutrition risk was 5.3 and malnutrition risk 2.9 times higher in those with high ADB among dementia patients (p<0.05); however, dysphagia was not different between the two groups (p>0.05). In non- dementia patients, when the effects of different variables such as gender, coronary artery disease, hypertension, HF, PD and decreased Barthel and Lawton scores were removed, it was found that there was no relationship ADB with malnutrition, dysphagia or loss of appetite (p>0.05). Conclusion: Anticholinergic drug use in is associated with malnutrition and an increased risk of malnutrition older Patients with dementia. Therefore, when arranging the treatment of dementia patients, drugs with low anticholinergic effects should be preferred and/or nutritional evaluation should be made while using these drugs in dementia patients. Keywords: malnutrition, dysphgia, anticholinergic burden, dementia