144 Polypharmacy and Anticholinergic Burden in Older People in Brunei Darussalam

Abstract

Abstract Introduction Polypharmacy and anticholinergic burden are associated with falls in older people. A longitudinal study found patients with five or more drugs had 21% increased falls over 2 years. [Dhalwani, Fahami, Sathanapally et al, BMJ Open, 2017,7(10), e016358]. A cohort study identified a 1.51 odds of recurrent falls with anticholinergic medication, while taking multiple anticholinergics resulted in 100% likelihood of recurrent falls. [Marcum, Wirtz, Pettinger, et al, BMC Geriatrics, 2016,16,76]. Methods Retrospective study of polypharmacy in older people in Brunei based on data from Bru-HIMS, the Brunei public healthcare sector electronic prescribing and pharmacy management system. In this national study, stratified sampling was done by district, with patients randomly selected within each district. Active medications were identified from Bru-HIMS. The Anticholinergic Cognitive Burden (ACB) Scale was used to calculate anticholinergic burden. Findings for two districts (Tutong and Temburong) are described. Results For the 327 patients, 142 (43%) were male and 185 (57%) female. Median age was 72 years (Range 65 to 103 years). 234 (72%) had 5 drugs or more prescribed. Of the 2332 prescriptions, 268 (11.5%) had anticholinergic activity on the ACB scale. Median ACB score was 1. The most commonly prescribed were Orphenadrine, Chlorpheniramine, Diphenhydramine, Cinnarizine and Amitriptyline. There was a positive correlation between polypharmacy and anticholinergic burden (r = 0.4593). Conclusion There was a high rate of polypharmacy in older people, with anticholinergic drug burden identified. It may be useful to educate clinicians and patients regarding risks of polypharmacy and anticholinergic burden, including falls.