Medications commonly prescribed for older adults may slow recovery after brain or spinal injury, according to research led by the University of East Anglia (UEA) in collaboration with other UK universities and the NHS, published in the journal Brain Injury.
Drugs with anticholinergic properties—used to treat frequent conditions such as urinary incontinence, depression and insomnia—are given to up to half of older adults. These medicines are known to cause side effects like short-term cognitive impairment, dizziness and confusion. Their specific impact on patients with pre-existing acquired brain or spinal cord injuries had not been thoroughly examined until this study.
The team investigated 52 patients admitted to a neuro-rehabilitation unit with acquired brain or spinal injuries. Researchers measured each patient’s anticholinergic drug burden (ACB), a score reflecting the cumulative anticholinergic effect of all medications a person is taking, and compared it with rehabilitation outcomes, including length of hospital stay.
Findings showed a clear association between changes in ACB during admission and length of stay. Patients whose ACB scores increased during their hospital stay tended to remain in the unit longer, while those whose ACB decreased on discharge compared with admission generally had shorter stays. The authors emphasize that, as an observational study, these results indicate correlation rather than proven causation and should be interpreted cautiously.
Dr Chris Fox, Professor of Clinical Psychiatry at UEA’s Norwich Medical School and lead author, commented: “Our results suggest a statistically significant relationship between ACB score and length of stay in a neuro-rehabilitation unit following traumatic brain or spinal cord injury.” He added that this pilot work highlights the need for larger, controlled studies to confirm these findings and to explore the longer-term effects of anticholinergic medications on recovery.
The researchers note that while anticholinergic drugs are often necessary to manage complications arising from brain or spinal cord injury—such as bladder dysfunction or pain—their cognitive side effects may reduce a patient’s ability to participate fully in rehabilitation. Reduced engagement in therapy could plausibly extend hospital stays, with implications for both patient outcomes and health service efficiency.
Dr Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston University, said: “This work adds to the evidence that anticholinergics should be avoided where possible across a wide range of patient groups. Regular medication review by a nurse, doctor or pharmacist may help ensure that anticholinergic medicines are used appropriately and only when their benefits outweigh potential harms.”
Professor Fox also highlighted the broader implications: “Identifying factors that may prolong a patient’s rehabilitation stay has both financial and quality-of-life consequences. If medication management can reduce unnecessary time in rehabilitation units, it could improve overall care efficiency while benefiting patients.”
Length of stay is frequently used as a performance metric in healthcare, with financial and operational incentives for discharging patients as soon as it is safely possible. Any avoidable factors that extend inpatient rehabilitation time therefore carry significance for service delivery as well as for patient recovery.
Source: Lucy Clegg – University of East Anglia
Image Credit: The image is credited to Liz Henry and is adapted from the University of East Anglia press release
Original Research: Abstract for “Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?” by M. Sakel et al., published in the journal Brain Injury. Published online August 5, 2015. doi:10.3109/02699052.2015.1060358
Abstract
Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?
Primary objective: To assess the relationship between disability, length of stay (LOS) and anticholinergic burden (ACB) in people recovering from acquired brain or spinal cord injury.
Research design: A retrospective case note review covering all admissions to a single rehabilitation unit.
Methods and procedures: The study reviewed 52 consecutive inpatients with acquired brain or spinal injury and neuropathy at a UK university hospital’s neuro-rehabilitation unit. Data collected included Northwick Park Dependency Score (NPDS), Rehabilitation Complexity Scale (RCS), Functional Independence Measure and Functional Assessment Measure (FIM-FAM, UK version 2.2), length of stay and ACB. Outcomes compared measures at admission versus discharge.
Main outcomes and results: The analysis found a positive association between changes in ACB and NPDS, while no significant effects were observed on FIM-FAM motor or cognitive subscales or on the RCS. Change in ACB correlated with length of hospital stay (regression correlation = −6.64; SE = 3.89). An increase in ACB during admission (from low to high) had a significant adverse effect on NPDS (OR = 9.65; 95% CI = 1.36–68.64) and on FIM-FAM total scores (OR = 0.03; 95% CI = 0.002–0.35).
Conclusions: In this patient cohort, higher anticholinergic burden was statistically associated with measures of neuro-disability and with longer length of stay. The authors call for further research to confirm these findings and to clarify causality.
“Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?” by M. Sakel, A. Boukouvalas, R. Buono, M. Moten, F. Mirza, W.-Y. Chan, I. Maidment, J. Cross, T. O. Smith, P. K. Myint, and C. Fox in Brain Injury. Published online August 5, 2015.