Association Between Anticholinergic Burden and Dry Mouth Severity in Acutely Ill Older Adults

Dry mouth is a common and burdensome condition in older adults and its severity may increase with use of anticholinergic medications. The aims were to describe anticholinergic medication use among acutely ill older adults, examine the association between anticholinergic burden and dry mouth severity using the composite Dry Mouth Severity Points (DMSP) measure and investigate whether the association differs by sex. Patients ≥70 years admitted to Oslo municipal inpatient acute care unit were eligible. Anticholinergic burden (ACB) was assessed using the ACB calculator and classified as 0, lower (ACB = 1–2) or high (ACB = ≥ 3). Dry mouth severity was quantified with DMSP, range 0–4, assigning one point for each indicator above cut-off: General Xerostomia Question ≥ 3, Summated Xerostomia Inventory ≥ 11, Clinical Oral Dryness Score ≥ 6 and unstimulated whole saliva secretion rate ≤ 0.1 mL/min. Associations were examined with ordinal logistic regression. Of 382 examined patients, 256 (mean age 84 ± 7 years, 70% women) had complete data. Mean standard deviation (SD) ACB score was 2.0 (1.7); 18% had ACB = 0, 50% had ACB = 1–2 and 32% had ACB = ≥ 3. DMSP scores of 0, 1, 2 and ≥ 3 were present in 29%, 36%, 23% and 12%, respectively. Compared with patients with ACB = 0, those with ACB = 1–2 [odds ratio (OR) = 2.06, 95% confidence interval (CI) 1.07–3.97) and ACB = ≥ 3 (OR = 2.25, 95% CI 1.09–4.63) had higher odds of more severe dry mouth. Women had significantly higher ACB and DMSP scores than men. Even lower anticholinergic burden was associated with greater dry mouth severity, highlighting the need for early recognition and proactive management in acutely ill older adults.