Potentially inappropriate anticholinergic medication use in older adults with dementia

Abstract

ObjectiveTo examine the prevalence and predictors of potentially inappropriate anticholinergic medication use in older adults with dementia. DesignA cross-sectional study. SettingUnited States, 2009–2010. ParticipantsMedical Expenditure Panel Survey participants aged 65years or older identified as having dementia. Main outcome measuresPrevalence and predictors of potentially inappropriate anticholinergic medication use as per the updated 2012 American Geriatrics Society Beers criteria. ResultsA total of 3.78 million older adult patients (95% confidence interval [CI] 3.17 million to 4.38 million) were identified as having dementia, for an overall prevalence of 4.81%. Of those patients, an estimated 1.02 million (95% CI 0.70 million to 1.30 million) were reported to use potentially inappropriate anticholinergic medications, for an overall prevalence of 26.95% (95% CI 20.10% to 33.79%). The most frequently prescribed drugs were oxybutynin, solifenacin, paroxetine, tolterodine, promethazine, and cyclobenzaprine. Multivariable logistic analysis revealed that patients with the need characteristics of self-reported anxiety, mood disorders, and “fair/poor” general health status had increased odds of potentially inappropriate anticholinergic use, while patients with the predisposing characteristic of being aged 75–84 years had decreased odds of potentially inappropriate anticholinergic use. ConclusionMore than one in four older adults with dementia were found to use potentially inappropriate anticholinergics. Given the adverse cognitive effects of these medications, there is a strong need to monitor and optimize their use in older adult patients with dementia.