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1.
Nat Ecol Evol ; 8(3): 430-441, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38278985

RESUMEN

Humans impact terrestrial, marine and freshwater ecosystems, yet many broad-scale studies have found no systematic, negative biodiversity changes (for example, decreasing abundance or taxon richness). Here we show that mixed biodiversity responses may arise because community metrics show variable responses to anthropogenic impacts across broad spatial scales. We first quantified temporal trends in anthropogenic impacts for 1,365 riverine invertebrate communities from 23 European countries, based on similarity to least-impacted reference communities. Reference comparisons provide necessary, but often missing, baselines for evaluating whether communities are negatively impacted or have improved (less or more similar, respectively). We then determined whether changing impacts were consistently reflected in metrics of community abundance, taxon richness, evenness and composition. Invertebrate communities improved, that is, became more similar to reference conditions, from 1992 until the 2010s, after which improvements plateaued. Improvements were generally reflected by higher taxon richness, providing evidence that certain community metrics can broadly indicate anthropogenic impacts. However, richness responses were highly variable among sites, and we found no consistent responses in community abundance, evenness or composition. These findings suggest that, without sufficient data and careful metric selection, many common community metrics cannot reliably reflect anthropogenic impacts, helping explain the prevalence of mixed biodiversity trends.


Asunto(s)
Biodiversidad , Ecosistema , Animales , Humanos , Invertebrados , Ríos , Europa (Continente)
2.
Ecology ; 105(2): e4219, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38037301

RESUMEN

A tenet of ecology is that temporal variability in ecological structure and processes tends to decrease with increasing spatial scales (from locales to regions) and levels of biological organization (from populations to communities). However, patterns in temporal variability across trophic levels and the mechanisms that produce them remain poorly understood. Here we analyzed the abundance time series of spatially structured communities (i.e., metacommunities) spanning basal resources to top predators from 355 freshwater sites across three continents. Specifically, we used a hierarchical partitioning method to disentangle the propagation of temporal variability in abundance across spatial scales and trophic levels. We then used structural equation modeling to determine if the strength and direction of relationships between temporal variability, synchrony, biodiversity, and environmental and spatial settings depended on trophic level and spatial scale. We found that temporal variability in abundance decreased from producers to tertiary consumers but did so mainly at the local scale. Species population synchrony within sites increased with trophic level, whereas synchrony among communities decreased. At the local scale, temporal variability in precipitation and species diversity were associated with population variability (linear partial coefficient, ß = 0.23) and population synchrony (ß = -0.39) similarly across trophic levels, respectively. At the regional scale, community synchrony was not related to climatic or spatial predictors, but the strength of relationships between metacommunity variability and community synchrony decreased systematically from top predators (ß = 0.73) to secondary consumers (ß = 0.54), to primary consumers (ß = 0.30) to producers (ß = 0). Our results suggest that mobile predators may often stabilize metacommunities by buffering variability that originates at the base of food webs. This finding illustrates that the trophic structure of metacommunities, which integrates variation in organismal body size and its correlates, should be considered when investigating ecological stability in natural systems. More broadly, our work advances the notion that temporal stability is an emergent property of ecosystems that may be threatened in complex ways by biodiversity loss and habitat fragmentation.


Asunto(s)
Ecosistema , Cadena Alimentaria , Biodiversidad , Agua Dulce , Factores de Tiempo
3.
Sci Total Environ ; 912: 169561, 2024 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-38142994

RESUMEN

The use of urban wastewater reclaimed water has recently increased across the globe to restore stream environmental flows and mitigate the effects of water scarcity. Reclaimed water is disinfected using different treatments, but their effects into the receiving rivers are little studied. Physiological bioassays and biomarkers can detect sub-lethal effects on target species, but do not provide information on changes in community structure. In contrast, official monitoring programs use community structure information but often at coarse taxonomic resolution level that may fail to detect species level impacts. Here, we combined commonly used biomonitoring approaches from organism physiology to community species composition to scan a broad range of effects of disinfection of reclaimed water by UV-light only and both UV/chlorine on the biota. We (1) performed bioassays in one laboratory species (water flea Daphnia magna) and measured biomarkers in two wild species (caddisfly Hydropsyche exocellata and the barbel Luciobarbus graellsii), (2) calculated standard indices of biotic quality (IBQ) for diatoms, benthic macroinvertebrates, and fishes, and (3) analysed community species composition of eukaryotes determined by Cytochrome Oxidase C subunit I (cox1) metabarcoding. Only the UV/chlorine treatment caused significant changes in feeding rates of D. magna and reduced antioxidant defenses, increased anaerobic metabolism and altered the levels of lipid peroxidiation in H. exocellata. However, inputs of reclaimed water were significantly associated with a greater proportion of circulating neutrophils and LG-PAS cells in L. graellsii. Despite IBQ did not discriminate between the two water treatments, metabarcoding data detected community composition changes upon exposure to UV/chlorine reclaimed water. Overall, despite the effects of UV/chlorine-treated water were transient, our study suggests that UV-light treated is less harmful for freshwater biota than UV/chlorine-treated reclaimed water, but those effects depend of the organizational level.


Asunto(s)
Aguas Residuales , Purificación del Agua , Animales , Cloro/química , Insectos , Desinfección , Cloruros , Biota , Ríos
4.
Nature ; 620(7974): 582-588, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37558875

RESUMEN

Owing to a long history of anthropogenic pressures, freshwater ecosystems are among the most vulnerable to biodiversity loss1. Mitigation measures, including wastewater treatment and hydromorphological restoration, have aimed to improve environmental quality and foster the recovery of freshwater biodiversity2. Here, using 1,816 time series of freshwater invertebrate communities collected across 22 European countries between 1968 and 2020, we quantified temporal trends in taxonomic and functional diversity and their responses to environmental pressures and gradients. We observed overall increases in taxon richness (0.73% per year), functional richness (2.4% per year) and abundance (1.17% per year). However, these increases primarily occurred before the 2010s, and have since plateaued. Freshwater communities downstream of dams, urban areas and cropland were less likely to experience recovery. Communities at sites with faster rates of warming had fewer gains in taxon richness, functional richness and abundance. Although biodiversity gains in the 1990s and 2000s probably reflect the effectiveness of water-quality improvements and restoration projects, the decelerating trajectory in the 2010s suggests that the current measures offer diminishing returns. Given new and persistent pressures on freshwater ecosystems, including emerging pollutants, climate change and the spread of invasive species, we call for additional mitigation to revive the recovery of freshwater biodiversity.


Asunto(s)
Biodiversidad , Conservación de los Recursos Hídricos , Monitoreo del Ambiente , Agua Dulce , Invertebrados , Animales , Especies Introducidas/tendencias , Invertebrados/clasificación , Invertebrados/fisiología , Europa (Continente) , Actividades Humanas , Conservación de los Recursos Hídricos/estadística & datos numéricos , Conservación de los Recursos Hídricos/tendencias , Hidrobiología , Factores de Tiempo , Producción de Cultivos , Urbanización , Calentamiento Global , Contaminantes del Agua/análisis
5.
Sci Total Environ ; 903: 166254, 2023 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-37574055

RESUMEN

Temporary rivers are widespread in the Mediterranean region and impose a challenge for the implementation of the Water Framework Directive (WFD) and other environmental regulations. Surprisingly, an overarching analysis of their ecological status and the stressors affecting them is yet missing. We compiled data on the ecological status of 1504 temporary rivers in seven European Mediterranean region countries and related their ecological status (1) to publicly available data on pressures from the European WISE-WFD dataset, and (2) to seven more specific stressors modelled on a sub-catchment scale. More than 50 % of the temporary water bodies in the Mediterranean countries reached good or even high ecological status. In general, status classes derived from phytobenthos and macrophyte assessment were higher than those derived from the assessment of benthic invertebrates or fish. Of the more generally defined pressures reported to the WISE-WFD database, the most relevant for temporary rivers were 'diffuse agricultural' and 'point urban waste water'. Of the modelled more specific stressors, agricultural land use best explained overall ecological status, followed by total nitrogen load, and urban land use, while toxic substances, total phosphorus load and hydrological stressors were less relevant. However, stressors differed in relevance, with total nitrogen being most important for macrophytes, and agricultural land use for phytobenthos, benthic invertebrates and fish. For macrophytes, ecological quality increased with stressor intensity. The results underline the overarching effect of land use intensity for the ecological status of temporary water bodies. However, assessment results do not sufficiently reflect hydrological stress, most likely as the biological indicators used to evaluate these systems were designed for perennial water bodies and thus mainly target land use and nutrient impacts. We conclude that biomonitoring systems need to be updated or newly developed to better account for the specific situation of temporary water bodies.

6.
Front Ecol Environ ; 20(1): 49-57, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35873359

RESUMEN

Regional-scale ecological processes, such as the spatial flows of material, energy, and organisms, are fundamental for maintaining biodiversity and ecosystem functioning in river networks. Yet these processes remain largely overlooked in most river management practices and underlying policies. Here, we propose adoption of a meta-system approach, where regional processes acting at different levels of ecological organization - populations, communities, and ecosystems - are integrated into conventional river conservation, restoration, and biomonitoring. We also describe a series of measurements and indicators that could be assimilated into the implementation of relevant biodiversity and environmental policies. Finally, we highlight the need for alternative management strategies that can guide practitioners toward applying recent advances in ecology to preserve and restore river ecosystems and the ecosystem services they provide, in the context of increasing alteration of river network connectivity worldwide.

7.
Sci Total Environ ; 842: 156689, 2022 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-35724793

RESUMEN

Humans have severely altered freshwater ecosystems globally, causing a loss of biodiversity. Regulatory frameworks, like the Water Framework Directive, have been developed to support actions that halt and reverse this loss. These frameworks use typology systems that summarize freshwater ecosystems into environmentally delineated types. Within types, ecosystems that are minimally impacted by human activities, i.e., in reference conditions, are expected to be similar concerning physical, chemical, and biological characteristics. This assumption is critical when water quality assessments rely on comparisons to type-specific reference conditions. Lyche Solheim et al. (2019) developed a pan-European river typology system, the Broad River Types, that unifies the national Water Framework Directive typology systems and is gaining traction within the research community. However, it is unknown how similar biological communities are within these individual Broad River Types. We used analysis of similarities and classification strength analysis to examine if the Broad River Types delineate distinct macroinvertebrate communities across Europe and whether they outperform two ecoregional approaches: the European Biogeographical Regions and Illies' Freshwater Ecoregions. We determined indicator and typical taxa for the types of all three typology systems and evaluated their distinctiveness. All three typology systems captured more variation in macroinvertebrate communities than random combinations of sites. The results were similar among typology systems, but the Broad River Types always performed worse than either the Biogeographic Regions or Illies' Freshwater Ecoregions. Despite reaching statistical significance, the statistics of analysis of similarity and classification strength were low in all tests indicating substantial overlap among the macroinvertebrate communities of different types. We conclude that the Broad River Types do not represent an improvement upon existing freshwater typologies when used to delineate macroinvertebrate communities and we propose future avenues for advancement: regionally constrained types, better recognition of intermittent rivers, and consideration of biotic communities.


Asunto(s)
Ecosistema , Ríos , Animales , Biodiversidad , Monitoreo del Ambiente/métodos , Humanos , Invertebrados
8.
Glob Chang Biol ; 28(15): 4620-4632, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35570183

RESUMEN

Globalization has led to the introduction of thousands of alien species worldwide. With growing impacts by invasive species, understanding the invasion process remains critical for predicting adverse effects and informing efficient management. Theoretically, invasion dynamics have been assumed to follow an "invasion curve" (S-shaped curve of available area invaded over time), but this dynamic has lacked empirical testing using large-scale data and neglects to consider invader abundances. We propose an "impact curve" describing the impacts generated by invasive species over time based on cumulative abundances. To test this curve's large-scale applicability, we used the data-rich New Zealand mud snail Potamopyrgus antipodarum, one of the most damaging freshwater invaders that has invaded almost all of Europe. Using long-term (1979-2020) abundance and environmental data collected across 306 European sites, we observed that P. antipodarum abundance generally increased through time, with slower population growth at higher latitudes and with lower runoff depth. Fifty-nine percent of these populations followed the impact curve, characterized by first occurrence, exponential growth, then long-term saturation. This behaviour is consistent with boom-bust dynamics, as saturation occurs due to a rapid decline in abundance over time. Across sites, we estimated that impact peaked approximately two decades after first detection, but the rate of progression along the invasion process was influenced by local abiotic conditions. The S-shaped impact curve may be common among many invasive species that undergo complex invasion dynamics. This provides a potentially unifying approach to advance understanding of large-scale invasion dynamics and could inform timely management actions to mitigate impacts on ecosystems and economies.


Asunto(s)
Ecosistema , Especies Introducidas , Animales , Europa (Continente) , Nueva Zelanda , Caracoles
9.
Sci Total Environ ; 804: 150022, 2022 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-34517322

RESUMEN

As complex mosaics of lotic, lentic, and terrestrial habitats, intermittent rivers and ephemeral streams (IRES) support high biodiversity. Despite their ecological importance, IRES are poorly represented in routine monitoring programs, but recent recognition of their considerable-and increasing-spatiotemporal extent is motivating efforts to better represent IRES in ecological status assessments. We examine response patterns of aquatic macroinvertebrate communities and taxa to flow intermittence (FI) across three European climatic regions. We used self-organizing map (SOM) to ordinate and classify sampling sites based on community structure in regions with continental, Mediterranean and oceanic climates. The SOM passively introduced FI, quantified as the mean annual % flow, and visualized its variability across classified communities, revealing a clear association between community structure and FI in all regions. Indicator species analysis identified taxa indicative of low, intermediate and high FI. In the continental region, the amphipod Niphargus was indicative of high FI and was associated with groundwater-fed IRES, whereas indicators of Mediterranean IRES comprised Odonata, Coleoptera and Heteroptera taxa, which favor lentic conditions. In the oceanic region, taxa indicative of relatively high FI included leuctrid stoneflies and a limnephilid caddisfly, likely reflecting the colonization of IRES by aerial adults from nearby perennial reaches. The Diptera families Chironomidae and Simuliidae showed contrasting FI preferences among regions, reflecting environmental heterogeneity between regions and the coarse taxonomic resolution to which these organisms were identified. These region-specific community and taxon responses of aquatic biota to FI highlight the need to adapt standard biotic indices to enable effective ecological status assessments in IRES.


Asunto(s)
Biomarcadores Ambientales , Ríos , Animales , Ecosistema , Monitoreo del Ambiente , Humanos , Insectos , Invertebrados
10.
Ecol Lett ; 25(2): 255-263, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34854211

RESUMEN

Global freshwater biodiversity is declining dramatically, and meeting the challenges of this crisis requires bold goals and the mobilisation of substantial resources. While the reasons are varied, investments in both research and conservation of freshwater biodiversity lag far behind those in the terrestrial and marine realms. Inspired by a global consultation, we identify 15 pressing priority needs, grouped into five research areas, in an effort to support informed stewardship of freshwater biodiversity. The proposed agenda aims to advance freshwater biodiversity research globally as a critical step in improving coordinated actions towards its sustainable management and conservation.


Asunto(s)
Conservación de los Recursos Naturales , Ecosistema , Biodiversidad , Agua Dulce
11.
Sci Data ; 7(1): 386, 2020 11 11.
Artículo en Inglés | MEDLINE | ID: mdl-33177529

RESUMEN

Dispersal is an essential process in population and community dynamics, but is difficult to measure in the field. In freshwater ecosystems, information on biological traits related to organisms' morphology, life history and behaviour provides useful dispersal proxies, but information remains scattered or unpublished for many taxa. We compiled information on multiple dispersal-related biological traits of European aquatic macroinvertebrates in a unique resource, the DISPERSE database. DISPERSE includes nine dispersal-related traits subdivided into 39 trait categories for 480 taxa, including Annelida, Mollusca, Platyhelminthes, and Arthropoda such as Crustacea and Insecta, generally at the genus level. Information within DISPERSE can be used to address fundamental research questions in metapopulation ecology, metacommunity ecology, macroecology and evolutionary ecology. Information on dispersal proxies can be applied to improve predictions of ecological responses to global change, and to inform improvements to biomonitoring, conservation and management strategies. The diverse sources used in DISPERSE complement existing trait databases by providing new information on dispersal traits, most of which would not otherwise be accessible to the scientific community.


Asunto(s)
Distribución Animal , Organismos Acuáticos , Invertebrados , Animales , Conservación de los Recursos Naturales , Ecología , Monitoreo del Ambiente , Europa (Continente)
12.
Bioscience ; 70(5): 427-438, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32440024

RESUMEN

Rapid shifts in biotic communities due to environmental variability challenge the detection of anthropogenic impacts by current biomonitoring programs. Metacommunity ecology has the potential to inform such programs, because it combines dispersal processes with niche-based approaches and recognizes variability in community composition. Using intermittent rivers-prevalent and highly dynamic ecosystems that sometimes dry-we develop a conceptual model to illustrate how dispersal limitation and flow intermittence influence the performance of biological indices. We produce a methodological framework integrating physical- and organismal-based dispersal measurements into predictive modeling, to inform development of dynamic ecological quality assessments. Such metacommunity-based approaches could be extended to other ecosystems and are required to underpin our capacity to monitor and protect ecosystems threatened under future environmental changes.

14.
Sci Data ; 7(1): 6, 2020 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-31913312

RESUMEN

The use of functional information in the form of species traits plays an important role in explaining biodiversity patterns and responses to environmental changes. Although relationships between species composition, their traits, and the environment have been extensively studied on a case-by-case basis, results are variable, and it remains unclear how generalizable these relationships are across ecosystems, taxa and spatial scales. To address this gap, we collated 80 datasets from trait-based studies into a global database for metaCommunity Ecology: Species, Traits, Environment and Space; "CESTES". Each dataset includes four matrices: species community abundances or presences/absences across multiple sites, species trait information, environmental variables and spatial coordinates of the sampling sites. The CESTES database is a live database: it will be maintained and expanded in the future as new datasets become available. By its harmonized structure, and the diversity of ecosystem types, taxonomic groups, and spatial scales it covers, the CESTES database provides an important opportunity for synthetic trait-based research in community ecology.


Asunto(s)
Biota , Animales , Biodiversidad , Ecología , Plantas
15.
Eur J Hosp Pharm ; 26(5): 262-267, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31656613

RESUMEN

OBJECTIVES: To evaluate characteristics of the medication complexity, risk factors associated with high medication complexity and their clinical consequences in patients with advanced chronic conditions. METHODS: A 10-month cross-sectional study was performed in an acute-hospital care Geriatric Unit. Patients with advanced chronic conditions were identified by the NECPAL test. Medication complexity was established using the Medication Regimen Complexity Index (MRCI) tool. Demographic, pharmacological and clinical patient data were collected with the objective of determining risk factors related to high medication complexity. Measured clinical outcomes were hospital length of stay, destination on hospital discharge, in-hospital mortality and 2-year survival. RESULTS: Two hundred and thirty-five patients (mean age 86.8, SD 5.37; 65.5% female) were recruited. MRCI's mean score was 38 points (SD 16.54, rank: 2.00-98.50), with 57.9% of patients with high medication complexity (MRCI >35 points).

16.
Glob Chang Biol ; 25(5): 1591-1611, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30628191

RESUMEN

Climate change and human pressures are changing the global distribution and the extent of intermittent rivers and ephemeral streams (IRES), which comprise half of the global river network area. IRES are characterized by periods of flow cessation, during which channel substrates accumulate and undergo physico-chemical changes (preconditioning), and periods of flow resumption, when these substrates are rewetted and release pulses of dissolved nutrients and organic matter (OM). However, there are no estimates of the amounts and quality of leached substances, nor is there information on the underlying environmental constraints operating at the global scale. We experimentally simulated, under standard laboratory conditions, rewetting of leaves, riverbed sediments, and epilithic biofilms collected during the dry phase across 205 IRES from five major climate zones. We determined the amounts and qualitative characteristics of the leached nutrients and OM, and estimated their areal fluxes from riverbeds. In addition, we evaluated the variance in leachate characteristics in relation to selected environmental variables and substrate characteristics. We found that sediments, due to their large quantities within riverbeds, contribute most to the overall flux of dissolved substances during rewetting events (56%-98%), and that flux rates distinctly differ among climate zones. Dissolved organic carbon, phenolics, and nitrate contributed most to the areal fluxes. The largest amounts of leached substances were found in the continental climate zone, coinciding with the lowest potential bioavailability of the leached OM. The opposite pattern was found in the arid zone. Environmental variables expected to be modified under climate change (i.e. potential evapotranspiration, aridity, dry period duration, land use) were correlated with the amount of leached substances, with the strongest relationship found for sediments. These results show that the role of IRES should be accounted for in global biogeochemical cycles, especially because prevalence of IRES will increase due to increasing severity of drying events.


Asunto(s)
Nutrientes/análisis , Compuestos Orgánicos/análisis , Ríos/química , Biopelículas/crecimiento & desarrollo , Disponibilidad Biológica , Clima , Cambio Climático , Sedimentos Geológicos/química , Nitratos/análisis , Hojas de la Planta/química
17.
Artículo en Inglés | MEDLINE | ID: mdl-30509911

RESUMEN

Abiotic stress shapes how communities assemble and support ecological functions. However, it remains unclear whether artificially increasing or decreasing stress levels would lead to communities assembling predictably along a single axis of variation or along multiple context-dependent trajectories of change. In response to stress intensity alterations, we hypothesize that a single trajectory of change occurs when trait-based assembly prevails, while multiple trajectories of change arise when dispersal-related processes modify colonization and trait-filtering dynamics. Here, we tested these hypotheses using aquatic macroinvertebrates from rivers exposed to gradients of natural salinity and artificially diluted or salinized ion contents. Our results showed that trait-filtering was important in driving community assembly in natural and diluted rivers, while dispersal-related processes seemed to play a relevant role in response to salinization. Salinized rivers showed novel communities with different trait composition, while natural and diluted communities exhibited similar taxonomic and trait compositional patterns along the conductivity gradient. Our findings suggest that the artificial modification of chemical stressors can result in different biological communities, depending on the direction of the change (salinization or dilution), with trait-filtering, and organism dispersal and colonization dynamics having differential roles in community assembly. The approach presented here provides both empirical and conceptual insights that can help in anticipating the ecological effects of global change, especially for those stressors with both natural and anthropogenic origins.This article is part of the theme issue 'Salt in freshwaters: causes, ecological consequences and future prospects'.


Asunto(s)
Biota , Invertebrados/fisiología , Ríos/química , Salinidad , Animales , Monitoreo del Ambiente , Estrés Fisiológico
19.
J Appl Ecol ; 55(1): 353-364, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29681651

RESUMEN

Intermittent rivers and ephemeral streams (IRES) are watercourses that cease flow at some point in time and space. Arguably Earth's most widespread type of flowing water, IRES are expanding where Anthropocenic climates grow drier and human demands for water escalate.However, IRES have attracted far less research than perennial rivers and are undervalued by society, jeopardizing their restoration or protection. Provision of ecosystem services by IRES is especially poorly understood, hindering their integration into management plans in most countries.We conceptualize how flow intermittence governs ecosystem service provision and transfers at local and river-basin scales during flowing, non-flowing and dry phases. Even when dry or not flowing, IRES perform multiple ecosystem services that complement those of nearby perennial rivers.Synthesis and applications. Conceptualizing how flow intermittence in rivers and streams governs ecosystem services has applied a socio-ecological perspective for validating the ecosystem services of intermittent rivers and ephemeral streams. This can be applied at all flow phases and in assessing impacts of altered flow intermittence on rivers and their ecosystem services in the Anthropocene.

20.
Geriatr Gerontol Int ; 18(8): 1159-1165, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29644803

RESUMEN

AIM: To evaluate the anticholinergic burden (ACB), the risk factors associated with its onset and the clinical consequences for patients with advanced chronic conditions. METHODS: A 10-month cross-sectional study was carried out in an acute hospital care geriatric unit. Patients with advanced chronic conditions were identified by the NECessity of PALliative care (NECPAL) test. The ACB was established using the Anticholinergic Drug Scale and Drug Burden Index (DBI) tools. Demographic, pharmacological and clinical patient data were collected with the objective of determining risk factors related to ACB. Measured clinical outcomes were the presence of acute confusional state, bone fractures, length of stay, mortality and 12-month survival rate. RESULTS: A total of 235 patients were recruited (mean age 86.80 years, SD 5.37 years; 65.50% women), and 82.10% (DBI) and 93.6% (Anticholinergic Drug Scale) of the patients were treated with anticholinergic medications. Excessive polypharmacy (≥10 drugs) was identified as a risk factor for the presence of anticholinergic medication (Anticholinergic Drug Scale: OR 6.26, 95% CI 1.38-28.42; DBI: OR 3.44, 95% CI 1.60-7.38). High anticholinergic burden (by DBI >2 points) was an independent risk factor for the presence of acute confusional state on hospital admission (OR 2.98, 95% CI 1.04-8.50). However, ACB was not related to bone fractures on admission, length of stay, mortality or survival. CONCLUSIONS: Patients with advanced chronic conditions are frequently treated with anticholinergic drugs, with excessive polypharmacy as a risk factor. Anticholinergic drugs are a risk factor for the presence of acute confusional state on hospital admission, but have no other effect in terms of morbimortality. Geriatr Gerontol Int 2018; 18: 1159-1165.


Asunto(s)
Antagonistas Colinérgicos/efectos adversos , Enfermedad Crónica/tratamiento farmacológico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/mortalidad , Mortalidad Hospitalaria , Admisión del Paciente/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Antagonistas Colinérgicos/uso terapéutico , Enfermedad Crónica/mortalidad , Estudios Transversales , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Femenino , Evaluación Geriátrica/métodos , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Modelos Logísticos , Masculino , Análisis Multivariante , Cuidados Paliativos/métodos , Polifarmacia , Prevalencia , Estudios Prospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , España , Análisis de Supervivencia
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