Anticholinergic drug exposure is associated with prevalence, worsening and incidence of dysphagia among hospitalized older adults

Objectives: In this study, we aimed at evaluating the association between anticholinergic drug exposure and prevalence, worsening, and incidence of dysphagia among hospitalized older individuals. Design and setting: We used data from the REPORT-Age project, a multicenter cohort study including patients aged 65 years or more, admitted to acute care hospitals of the Italian National Institute for Health and Sciences on Aging (INRCA-IRCCS) between 2011 and 2019. Participants: 4,005 older patients aged 84.7 (SD = 6.6) years underwent comprehensive geriatric examination according to the interRAI minimum dataset for acute care (MDS-AC), at both hospital admission and discharge. Measurements: Both prevalence and severity of dysphagia were assessed through items of subjective evaluation included in the section K3 of MDS-AC questionnaire; the anticholinergic drug exposure was measured by means of CRIDECO Anticholinergic Load Scale (CALS) and Anticholinergic Cognitive Burden (ACB) scales. Next, we used logistic regression models to evaluate the association between anticholinergic burden and prevalence of dysphagia at hospital admission; Kaplan Meier cumulative probability curves and cox proportional hazard models were used to analyze the association between anticholinergic burden at hospital admission and worsening or incidence of dysphagia during hospital stay. Results: Out of 4,005 patients included, 1,070 (30%) presented dysphagia at hospital admission. High anticholinergic burden was associated with increased prevalence of dysphagia at hospital admission (p < 0.001). Moreover, patients with high anticholinergic burden (ACB and CALS ≥ 2) were at increased risk of dysphagia worsening during hospital stay (HR, 95%CI: 1.14, 1.06-1.22 and 1.12, 1.03-1.23 for ACB and CALS respectively). Among the 2,935 patients with normal swallowing function at hospital admission, high anticholinergic burden was associated with the incidence of dysphagia at hospital discharge (HR, 95% CI: 1.89, 1.21-2.96 and 1.86, 1.14-3.06 for ACB and CALS respectively). Development of dysphagia during hospital stay was associated with a reduced prescription of anticholinergic medications (ORs, 95% CI 1.13 (1.07-1.20) and 1.08 (1.01-1.15) for ACB and CALS, respectively). Conclusions: Increased anticholinergic burden was associated with the prevalence, worsening, and incidence of dysphagia among older hospitalized patients.