Abstract
Background: The use of drugs with anticholinergic effects among elderly patients is associated with adverse clinical outcomes. There is paucity of information about anticholinergic drug burden among Nigerian elderly population. Objectives: To determine the anticholinergic drug burden among elderly Nigerian patients. Methods: This was a retrospective cross-sectional study conducted among elderly patients (aged 65 and above) who visited the Family Medicine outpatients’ clinics of the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria between July 1 and October 31, 2018. Information extracted from the case files included patient’s age, sex, diagnoses, and list of prescribed medications. Medicines with anticholinergic effects were identified and scored using the anticholinergic drug burden calculator (http://www.acbcalc.com). Results: The medical records of 400 patients were analyzed with females accounting for 60.5% of the study population. The mean age of participants was 73 ± 7.4 years with only 28 (7%) of patients having more than two co-morbid conditions. Polypharmacy was identified in 152 (38%) of the patients while 147 (36.7%) had drugs with anticholinergic effects prescribed. The anticholinergic burden was high in 60 (15%) patients. Polypharmacy was significantly associated with having more than two diagnosed conditions and high anticholinergic burden (p value of < 0 .001 and 0.013 respectively). There was significant correlation between total number of prescribed drugs and count of diagnoses (r = 0.598; p < 0 .000) and between total number of prescribed drugs and number of drugs with anticholinergic effects (r = 0 .196; p < 0 .000). Conclusion: The anticholinergic burden in this group of elderly Nigerian patients was low; majority (67%) had no exposure to drugs with anticholinergic effects with only 15% having high anticholinergic burden. Polypharmacy and multiple diagnosed conditions were positively associated with high anticholinergic burden. Based on the positive and significant correlations found in this study, a reduction in the number of prescribed medicines especially those with significant anticholinergic effects used for secondary indications may lessen the anticholinergic burden among the elderly.
Highlights
Medication use among elderly patients is often associated with adverse drug reactions (Davies and O’Mahony, 2015)
Drugs with anticholinergic effects are prominent in the list of potentially inappropriate medicines prescription for the elderly such as those listed in the Beers, STOPP and PRISCUS criteria (Holt et al, 2010; American Geriatrics Society, 2015; O’mahony, 2020)
The clinic has a specialized geriatrics clinic to cater for the needs of elderly patients who account for a large proportion of patients presenting to the Family Medicine department
Summary
Medication use among elderly patients is often associated with adverse drug reactions (Davies and O’Mahony, 2015). Several tools have been developed and validated to assess the burden of anticholinergic drugs among elderly patients These include the Anticholinergic Risk Scale (ARS), Anticholinergic Cognitive Burden (ACB) Scale, Anticholinergic Drug Scale (ADS) and Drug Burden Index anticholinergic component (DBI-ACh) (Narayan et al, 2013; Salahudeen et al, 2015). There is paucity of information about the use of drugs with anticholinergic effects and anticholinergic drug burden among elderly patients in SubSaharan Africa, especially in Nigeria. This is not surprising as the specialty of geriatric medicine is just being given necessary attention and recognition in Nigeria. There is paucity of information about anticholinergic drug burden among Nigerian elderly population
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