Abstract
Background: Anticholinergic medications may be associated with adverse clinical outcomes, including acute impairments in cognition and anticholinergic side effects, the risk of adverse outcomes increasing with increasing anticholinergic exposure. Older people with intellectual disability may be at increased risk of exposure to anticholinergic medicines due to their higher prevalence of comorbidities. We sought to determine anticholinergic burden in ageing people with intellectual disability. Methods: Medication data (self-report/proxy-report) was drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a study on the ageing of 753nationally representative people with an IDC40 years randomly selected from the National Intellectual Disability Database. Each individual’s cumulative exposure to anticholinergic medications was calculated using the Anticholinergic Cognitive Burden Scale (ACB) amended by a multi-disciplinary group with independent advice to account for the range of medicines in use in this population. Results: Overall, 70.1 % (527) reported taking medications with possible or definite anticholinergic properties (ACBC1), with a mean (±SD) ACB score of 4.5 (±3.0) (maximum 16). Of those reporting anticholinergic exposure (n=527), 41.3 % (217) reported an ACB score o fC5. Antipsychotics accounted for 36.4 % of the total cumulative ACB score followed by anticholinergics (16 %) and antidepressants (10.8 %). The most frequently reported medicine with anticholinergic activity was carbamazepine 16.8 % (127). The most frequently reported medicine with high anticholinergic activity (ACB 3) was olanzapine13.4 % (101). There was a significant association between higher anti-cholinergic exposure and multimorbidity, particularly mental health morbidity, and some anticholinergic adverse effects such as constipation and day-time drowsiness but not self-rated health. Conclusion: Using simple cumulative measures proved an effective means to capture total burden and helped establish that anticholinergic exposure in the study population was high. The finding highlights the need for comprehensive reviews of medications.
Highlights
Post-stroke hypertension is common and is associated with a worse prognosis
systolic blood pressure (SBP) is markedly raised compared with usual pre-morbid levels after intracerebral haemorrhage (ICH), whereas acute-phase SBP after major ischaemic stroke is much closer to the accustomed long-term pre-morbid level
Two-year incidence rates are calculated as the number of individuals who newly report a health condition at wave 2 expressed as a proportion of those individuals who were free of this condition in wave 1
Summary
Post-stroke hypertension is common and is associated with a worse prognosis. no study has analysed pre-morbid BP to determine whether acute-phase levels are unaccustomed. Results: Utilisation of LSW in practice facilitated the delivery of person- centred care that promoted the wellbeing of the person with dementia by relieving loneliness, reducing anxiety and agitation and promoting feelings of trust and security Both the nurses and healthcare assistants recognised that they had role in Life Story Work, whether it was gathering, documenting or communicating the information. The HIQA quality standards for residential care for older people in Ireland recommend that the residents care plan should meet each resident’s assessed needs which are set out in an individual care plan, developed and agreed with each resident, or in the case of a resident with cognitive impairment with his/her representative This poses a challenge for nurses as many are only familiar with care planning in the acute hospital setting rather than in the residential care setting. This project has significant impact for older people who must have their autonomy, dignity and personhood maintained amidst their physical and cognitive decline
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