Anticholinergic Burden: Clinical Implications for Seniors and Strategies for Clinicians

Abstract

To review the current literature assessing the risks associated with the use of anticholinergic (AC) medications in older adults and to provide recommendations for pharmacists to incorporate the evaluation of AC burden as a component of a medication therapy management program for older adults. A MEDLINE/PubMed search was conducted from January 1990 to July 2011 using the terms anticholinergic, antimuscarinic, geriatric, aged, and elderly. References cited in studies and reviews identified in this search were also evaluated. Articles published in languages other than English or conducted in nonhuman species were not evaluated. Studies and reviews were included if they evaluated adverse events associated with the use of AC medications in the older adult population. Data were extracted by the method of independent extraction by multiple observers based on their selection of sections. The review presents evidence that AC medications are associated with negative outcomes in older adults and the importance of health care provider interventions to avoid these consequences. AC burden is associated with adverse drug events and negative health outcomes in older adults. Health care providers should carefully assess the risks versus benefits of using medications with AC properties to minimize AC burden and prevent adverse outcomes in this vulnerable patient population. AC burden should be considered as acomponent of a medication therapy management program for seniors.