Abstract
The use of prescription drugs with anticholinergic properties has been associated with multiple negative health outcomes in older people. Moreover, recent evidence suggests that associated adverse effects may occur even decades after stopping anticholinergic use. Despite the implicated importance of examining longitudinal patterns of anticholinergic prescribing for different age groups, few such data are available. We performed an age-period-cohort (APC) analysis to study trends in an aggregate measure of anticholinergic burden between the years 1990 and 2015, utilising data from >220 000 UK Biobank participants with linked prescription data from primary care. Anticholinergic burden in the sample increased up to 9-fold over 25 years and was observed for both period and age effects across most classes of drugs. The greatest increase was seen in the prescribing of antidepressants. Female sex, lower education and greater deprivation were associated with greater anticholinergic burden. The increase in anticholinergic prescribing is mostly due to an increase in polypharmacy and is attributable to both ageing of participants and period-related changes in prescribing practices. Research is needed to clarify the implications of rising anticholinergic use for public health and to contextualise this rise in light of other relevant prescribing practices.
Highlights
Medicines with anticholinergic properties – antagonists to muscarinic receptors in the nervous system – are found among various classesThis is a secondary investigation of an existing cohort study and did not have a Principal Investigator.of drugs.[1]
Anticholinergic prescriptions constituted 2.5-23.1% of all prescriptions (Table 2) and anticholinergic burden according to each scale exhibited an increasing trend over time (Figure 1A)
The period effect was retained, but the effect of age was reversed when adjusted for the number of prescribed drugs. These results possibly indicate that whereas overall anticholinergic burden has increased over time, and more so among older adults, anticholinergic drugs in the latter group comprise a relatively lower proportion of overall prescriptions when compared to younger individuals (Supporting Information Figure S7)
Summary
Medicines with anticholinergic properties – antagonists to muscarinic receptors in the nervous system – are found among various classesThis is a secondary investigation of an existing cohort study and did not have a Principal Investigator.of drugs.[1]. Medicines with anticholinergic properties – antagonists to muscarinic receptors in the nervous system – are found among various classes. This is a secondary investigation of an existing cohort study and did not have a Principal Investigator. The use of prescription drugs with anticholinergic properties has been associated with multiple negative health outcomes in older people. Methods: We performed an age-period-cohort (APC) analysis to study trends in an aggregate measure of anticholinergic burden between the years 1990 and 2015, utilising data from >220 000 UK Biobank participants with linked prescription data from primary care. Results: Anticholinergic burden in the sample increased up to 9-fold over 25 years and was observed for both period and age effects across most classes of drugs. Research is needed to clarify the implications of rising anticholinergic use for public health and to contextualise this rise in light of other relevant prescribing practices
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