New research reveals that a class of drugs prescribed to treat common conditions ranging from bladder problems, depression and insomnia in up to 50% of older patients may delay their recovery from brain injury.
Anticholinergics are already known to have side effects, including temporary cognitive impairment, confusion and dizziness. But the new study led by the University of East Anglia (UEA) in the UK is the first to investigate their effects on patients with brain injury.
The researchers, including scientists from Aston University, other UK research centers and the British National Health Service, report their findings in the journal Brain Injury.
The study investigated 52 patients who had suffered brain or spinal injury and were treated at a neuro-rehabilitation unit.
Patients undergoing neuro-rehabilitation are often given anticholinergics to relieve pain, urinary incontinence and other conditions.
The researchers found that the average length of stay among the patients they studied was longer for those with higher levels of anticholinergic drug burden (ACB) in their system.
The analysis showed a direct correlation between changes in ACB and length of hospital stay. Patients whose ACB scores on discharge were higher than on admission stayed longer in hospital and patients whose ACB scores on discharge were lower spent less time in hospital on average.
However, the researchers point out their study was not designed to prove cause and effect; it can only show there is a link.
Senior author Chris Fox, a professor of clinical psychiatry at Norwich Medical School at UEA, says:
“This pilot study demonstrates the need for larger studies to confirm the results and need for further investigation into what long-term effects these common medications are having on the recovery of these patients.”
He explains that while it is often necessary to treat common complications of brain and spinal cord injuries with anticholinergic drugs, medication side effects such as cognitive impairment can get in the way of patients being able to engage fully in their rehabilitation, resulting in a longer hospital stay.
Co-author Dr. Ian Maidment, who lectures in clinical pharmacy at Aston’s School of Life & Health Sciences, says their findings add to the evidence that, where possible, anticholinergics should be avoided in a wide range of populations.
“Regular medication review by a nurse, doctor or pharmacist may be a way of ensuring that medicines with anticholinergic effects are used appropriately,” he suggests.
The study is important not just for clinical reasons but also because one of the measures of hospital performance is length of stay, and there are financial incentives for discharging patients as soon as is safe.
Prof. Fox concludes:
“Identifying factors which might adversely affect the length of a patient’s stay can have important financial as well as quality of life implications.”
Therefore, he adds, the study’s findings may help improve wider efficiency of health care by reducing the time patients spend in rehabilitation.
Earlier this year, Medical News Today also learned of a significant link between high use of anticholinergic drugs and increased risk of developing dementia and Alzheimer’s disease in older people.