Abstract
Background: Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and there is no specific intervention strategy for reducing drug burden from anticholinergic activity medications. Little is known about the effectiveness of current interventions that may likely improve the anticholinergic prescribing practice in older adults. Aims: This review seeks to document all types of interventions aiming to reduce anticholinergic prescribing among older adults and assess the current evidence and quality of existing single and combined interventions. Methods: We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO from January 1990 to August 2021. Only studies that examined the effect of interventions in older people focused on improving compliance with anticholinergic prescribing guidelines with quantifiable data were included. The primary outcome of interest was to find the effectiveness of interventions that enhance the anticholinergic prescribing practice in older adults. Results: We screened 3168 records and ended up in 23 studies that met the inclusion criteria. We found only single-component interventions to reduce anticholinergic prescribing errors in older people. Pharmacists implemented interventions without collaboration in nearly half of the studies (n = 11). Medication review (43%) and education provision (26%) to healthcare practitioners were the most common interventions. Sixteen studies (70%) reported significant reductions in anticholinergic prescribing errors, whereas seven studies (30%) showed no significant effect. Conclusion: This systematic review suggests that healthcare practitioner-oriented interventions have the potential to reduce the occurrence of anticholinergic prescribing errors in older people. Interventions were primarily effective in reducing the burden of anticholinergic medications and assisting with deprescribing anticholinergic medications in older adults.
Highlights
Prescribing medications among older adults is recognised as a challenging task and an essential practice that needs to be continuously monitored, assessed, and refined
Most medications commonly prescribed to older people are not routinely recognised as having anticholinergic activity, and empirically, clinicians prescribe these medicines based on their anticipated therapeutic benefits while overlooking the risk of cumulative anticholinergic burden [14,15,16]
The central adverse effects of anticholinergic medications are attributed to the excess blocking of cholinergic receptors within the central nervous system (CNS) [16]
Summary
Prescribing medications among older adults is recognised as a challenging task and an essential practice that needs to be continuously monitored, assessed, and refined . It is based on understanding clinical pharmacology principles, knowledge 4.0/). Older people are vulnerable to the adverse effects from medicines with anticholinergic-type effects [12,13]. Most medications commonly prescribed to older people are not routinely recognised as having anticholinergic activity, and empirically, clinicians prescribe these medicines based on their anticipated therapeutic benefits while overlooking the risk of cumulative anticholinergic burden [14,15,16]. The commonly reported central adverse effects are cognitive impairment, headache, reduced cognitive function, anxiety, and behavioural disturbances [16]
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