Prescription Of Anticholinergic Drugs Research Articles

Polypharmacy in Older Patients: A Three-Year Longitudinal Analysis in Primary Care Settings of Aragón, Spain.

Challenges of polypharmacy and the impact of coronavirus disease 2019 (COVID-19) pandemic in older patients require further investigation. This retrospective study analyzed the progression of polypharmacy and anticholinergic burden in older patients in a primary care setting before, during, and after the COVID-19 pandemic. This 3-year cross-sectional study (2019, 2020, and 2021) comprised a dynamic cohort of individuals aged ≥75 years, who attended the Arrabal Primary Care Center in Zaragoza, Spain. Older patients with polypharmacy (≥5 medications) were identified according to their electronic health records. We collected demographic and clinical data, including medication prescriptions, diagnoses, and anticholinergic risks, and performed descriptive and statistical analyses. This study included a total of 1,928 patients with a mean age of 83.52±0.30 years. Over the 3-year study period, the mean number of medications prescribed increased, from 9.4 in 2019 to 10.4 in 2021. The prevalence of excessive polypharmacy (≥10 medications) increased from 39% in 2019 to 45% in 2021. The most commonly prescribed drugs were anilides, proton pump inhibitors, benzodiazepine derivatives, and platelet aggregation inhibitors. Women had a higher prevalence of illnesses and anticholinergic drug prescriptions than men. The results of this study highlighted an upward trend in polypharmacy and excessive polypharmacy among older patients in primary care settings. Future research should focus on optimizing medication management and deprescribing strategies and minimizing the adverse effects of polypharmacy in this population.

Prescription of Anticholinergic Drugs in Patients With Schizophrenia: Analysis of Antipsychotic Prescription Patterns and Hospital Characteristics.

In several clinical guidelines for schizophrenia, long-term use of anticholinergic drugs is not recommended. We investigated the characteristics of the use of anticholinergics in patients with schizophrenia by considering psychotropic prescription patterns and differences among hospitals. A cross-sectional, retrospective prescription survey at the time of discharge was conducted on 2027 patients with schizophrenia from 69 Japanese hospitals. We examined the relations among psychotropic drug prescriptions regarding anticholinergic prescription. We divided the hospitals into three groups—low rate group (LG), medium rate group (MG), and high rate group (HG)—according to their anticholinergic prescription rates, and analyzed the relationship between anticholinergic prescription rates and antipsychotic prescription. Anticholinergic drugs were prescribed to 618 patients (30.5%), and the prescription rates were significantly higher for high antipsychotic doses, antipsychotic polypharmacy, and first-generation antipsychotics (FGAs) use. The anticholinergic prescription rate varied considerably among hospitals, ranging from 0 to 66.7%, and it was significantly higher in patients with antipsychotic monotherapy, antipsychotic polypharmacy, and normal and high doses of antipsychotics in HG than in those LG and MG. The anticholinergics prescription rate in patients with second-generation antipsychotic monotherapy in HG was also significantly higher than in those LG and MG; however, the difference was no longer significant in patients with FGA monotherapy. Conclusively, in addition to high antipsychotic doses, antipsychotic polypharmacy, and FGA use, hospital characteristics influence the prescribing of anticholinergic drugs.

Anticholinergic drugs and forebrain magnetic resonance imaging changes in cognitively normal people and those with mild cognitive impairment.

Background and purposeAnticholinergic (AC) medication use is associated with cognitive decline and dementia, which may be related to an AC‐induced central hypocholinergic state, but the exact mechanisms remain to be understood. We aimed to further elucidate the putative link between AC drug prescription, cognition, and structural and functional impairment of the forebrain cholinergic nucleus basalis of Meynert (NBM).MethodsCognitively normal (CN; n = 344) and mildly cognitively impaired (MCI; n = 224) Alzheimer’s Disease Neuroimaging Initiative Phase 3 participants with good quality 3‐T magnetic resonance imaging were included. Structural (regional gray matter [GM] density) and functional NBM integrity (functional connectivity [FC]) were compared between those on AC medication for > 1 year (AC+) and those without (AC−) in each condition. AC burden was classed as mild, moderate, or severe.ResultsMCI AC+ participants (0.55 ± 0.03) showed lower NBM GM density compared to MCI AC− participants (0.56 ± 0.03, p = 0.002), but there was no structural AC effect in CN. NBM FC was lower in CN AC+ versus CN AC− (3.6 ± 0.5 vs. 3.9 ± 0.6, p = 0.001), and in MCI AC+ versus MCI AC− (3.3 ± 0.2 vs. 3.7 ± 0.5, p < 0.001), with larger effect size in MCI. NBM FC partially mediated the association between AC medication burden and cognition.ConclusionsOur findings provide novel support for a detrimental effect of mild AC medication on the forebrain cholinergic system characterized as functional central hypocholinergic that partially mediated AC‐related cognitive impairment. Moreover, structural tissue damage suggests neurodegeneration, and larger effect sizes in MCI point to enhanced susceptibility for AC medication in those at risk of dementia.

A qualitative study of the perception of nursing home practitioners about the implementation of quality indicators for drug consumption in nursing homes.

IntroductionNursing homes (NHs) are an ideal environment in which to implement interventions aimed at reducing inappropriate prescriptions. Quality indicators (QIs) may be useful to standardize practices, but it is unclear how they mediate change. In the framework of a quantitative study aimed at reducing the prescription of anticholinergic drugs among NH residents using QIs, we performed a qualitative study to describe the investigators’ perception of the utility of QIs.MethodsQualitative study using focus group methodology. Focus groups were recorded and transcribed, and analyzed by thematic analysis. Participants were purposefully recruited from among the medical directors of the NHs in the quantitative study.ResultsFive medical directors participated in two focus group meetings. The main themes to emerge were: (1) communication is key to introducing new practices and achieving lasting uptake; (2) improved coordination and communication provided useful information to help interpret the quantitative results observed: e.g., participants reported that they were able to obtain contextual and patient-specific information that explained why some prescribers had consistently, but justifiably “poor” performance on the quantitative indicators; (3) negative aspects reported included reluctance to change among prescribers and the tendency to shirk responsibility.ConclusionFrom the point of view of medical directors of NHs participating in an interventional program to reduce inappropriate prescriptions of anticholinergic drugs, the main factor driving the success of the program was communication, which is key to achieving adherence. Improved communication provides useful insights into the reasons why no quantitative reduction is observed in objective quality indicators.

Prescription of Anticholinergics in Tardive Syndromes: A "Dual Center" Survey among Psychiatrists.

Methods We assessed the attitude of two groups of psychiatrists (practicing in Italy and Thailand) towards the prescription of anticholinergics by a short online survey consisting of four questions. A total of one hundred questionnaires were sent out (50 in Italy and 50 in Thailand), and 42 psychiatrists responded to the survey. Results When comparing the two cohorts, the difference, both for age and years of practice, was statistically significant (p < 0.00001 and p < 0.0001, respectively), with Thai psychiatrists being younger and with less time in practice as specialists. The results from the survey showed that the prescription of anticholinergic drugs at the beginning of the antipsychotic treatment was used by 5 psychiatrists (20.0%) of the Italian cohort and by 1 (5.9%) of the Thai cohort. Regarding the Italian psychiatrists who did not prescribe anticholinergics concomitantly with neuroleptics, we found that 5 (25.0%) of them had prescribed anticholinergics in the past but had abandoned this practice, while 15 (93.7%) of the Thai psychiatrists who did not prescribe anticholinergics at the moment of the survey answered that they had prescribed these drugs in the past. Conclusion According to this preliminary survey, the practice to use anticholinergics as a treatment for tardive syndromes is still relatively common, particularly in psychiatrists of the older generation, but seemingly in decline over the years.

ANTICHOLINERGIC DRUGS: CUT-OFF FOR IMPAIRED COGNITION AND MOBILITY IN SENIORS

Background and Objectives: Anticholinergic drugs are commonly prescribed in older adults despite growing evidence of their adverse outcomes. We aimed to improve knowledge about deleterious effects of anticholinergic drugs on both cognition and mobility, in particular whether there is a threshold value for the number of anticholinergic drugs or for the anticholinergic burden leading to mobility or cognitive impairment. Methods: 177 community-dwelling individuals aged 55 years or over, with a fall history in the previous year, took part in the study. Anticholinergic drugs were identified using the Anticholinergic Drug Scale (ADS), and global cognition and mobility were assessed using the Mini Mental State Examination (MMSE) and the Time-Up-and-Go (TUG) test, respectively. Results: ROC (Receiver Operating Characteristics) curve analysis indicated that consumption of a single anticholinergic drug per day was a risk factor for impaired MMSE (p < .05) and TUG scores (p < .05). There was also a cut-off of anticholinergic burden of one for impaired MMSE scores (p < .05). Logistic regressions showed that impaired cognition induced by anticholinergic drugs were independent of confounding factors including comorbidities, while impaired mobility would be influenced by age and cardiac comorbidities. Conclusion: Daily consumption of a single anticholinergic drug, regardless of its anticholinergic burden, impairs both cognition and mobility community-dwelling seniors. Alternative solutions to anticholinergic drug prescription should thus be considered whenever possible.

Multidrug use positively correlates with high-risk prescriptions in the Japanese elderly: a longitudinal study

BackgroundThere is a lack of evidence that multidrug use triggers adverse events. Therefore, the main purpose of this study was to clarify the relationship between the total number of drugs and number of high-risk prescriptions administered to Japanese elderly patients.MethodsUsing hospital electronic medical records (EMR), we evaluated the prescriptions of outpatients aged 65 years or older. We defined prescriptions of potentially inappropriate medications (PIMs) and overlapping prescription of drugs with the same mechanism of action (DSAs) as high-risk prescriptions. We analyzed the relationship among total number of drugs and high-risk prescriptions. In addition, we performed a secondary research to determine whether the hospitalization rate and concomitant medication contents differ depending on the high-risk prescriptions.ResultsData for 13,630 outpatients were analyzed. A significant positive correlation between the numbers of total drugs and PIMs was found. The prescription frequency of individual PIMs rose as the total number of prescription drugs increased. The odds ratio (OR) of overlapping DSAs was significantly higher in patients using 5 or more drugs. In addition, there were significantly more prescriptions of laxatives among patients with overlapping prescriptions of anticholinergic drugs. The use of almost all PIMs was not an independent risk factor for hospitalization; instead, the number of PIMs was an independent risk factor for hospitalization [OR 1.18 (95% CI, 1.12–1.26)].ConclusionsThe number of PIMs and overlapping DSAs were high in patients receiving multidrug treatment. To avoid adverse events and hospitalization, it might be useful to review prescriptions and consider the number of PIMs and overlapping DSAs.

Association between anticholinergic (atropinic) drug exposure and cognitive function in longitudinal studies among individuals over 50 years old: a systematic review.

With increasing age, adults are often exposed to anticholinergic drugs and are prone to potential adverse drug reaction, among which cognitive impairment. If the short-term cognitive effects of anticholinergic drugs are well established, their long-term cognitive effects have less been studied. To provide a systematic review of longitudinal studies which assessed the effect of anticholinergic exposure on cognition in individuals over 50years. We searched the MEDLINE database for studies with a minimal 6-month follow-up, assessing anticholinergic exposure through a biological measure or a clinical list and reporting at least one cognitive outcome. We used the modified Newcastle-Ottawa scale and additional criteria regarding the anticholinergic exposure to assess studies' methodological quality. Given the heterogeneity of the studies, we performed a systematic review. Among the 1574 references retrieved, 25 studies were included. Anticholinergic medications were mostly defined through the Anticholinergic Cognitive Burden Scale (n = 14/25). Six studies evaluated baseline drug collection, 14 used longitudinal aggregated measure, and 5 multiple drug exposure measures over time. Seventeen studies assessed anticholinergic burden. Cognitive function was assessed by mild cognitive impairment/dementia incidence (n = 15) or neuropsychological tests (n = 14). Most studies were of poor quality and retrieved discordant results. However, studies with good quality (n = 4) suggested a relationship between anticholinergic drug exposure and/or burden and cognitive function. Our review suggests a deleterious effect of anticholinergic exposure on mid/long-term cognitive function but should be confirmed in studies with improved methodology. Meanwhile, prescription of anticholinergic drugs should remain cautious.

Potentially inappropriate anticholinergic drug prescriptions for patients with Sjögren's syndrome

Sjögren's syndrome is characterized by the involvement of exocrine glands, manifesting with xerostomia and xerophthalmia. The objective was to determine the treatment received and identify potentially inappropriate prescriptions by estimating the anticholinergic burden generated by medications in patients with Sjögren's syndrome in Colombia. This cross-sectional study was based on a population database that identified patients with Sjögren's syndrome, comorbidities, pharmacological treatment, and medications with anticholinergic properties. The anticholinergic burden was estimated using the Anticholinergic Drug Scale. A total of 4945 patients with Sjögren's syndrome were identified, with a mean age of 64.6 ± 14.04 years and 75.7% women. A total of 79.0% received a topical lubricant, with hyaluronate being the most prescribed (26.8%), while oral pilocarpine was prescribed for 7.4%. The use of biological disease-modifying antirheumatic drugs was identified in 1.3% of cases. A total of 39.1% (n = 1932) of all patients received cholinergic antagonists, especially codeine (6.5%), prednisolone (5.7%), and furosemide (5.3%). The mean anticholinergic burden was 0.91 ± 1.57 (range: 0–24), 17.2% (n = 850) had a score of 1, 7.7% (n = 381) had a score of 2, and 14.2% (n = 701) ≥3 points. Multiple comorbidities were associated with the risk of having cholinergic antagonist medication prescribed. Most patients with Sjögren's syndrome were women whose symptomatic management mainly included ocular lubricants with low use of oral pilocarpine. A large proportion of patients had at least one cholinergic antagonist drug prescribed, increasing its use risk after 40 years of age.

Anticholinergic Drug Exposure and the Risk of Dementia

Anticholinergic medicines have short-term cognitive adverse effects, but it is uncertain whether long-term use of these drugs is associated with an increased risk of dementia. To assess associations between anticholinergic drug treatments and risk of dementia in persons 55 years or older. This nested case-control study took place in general practices in England that contributed to the QResearch primary care database. The study evaluated whether exposure to anticholinergic drugs was associated with dementia risk in 58 769 patients with a diagnosis of dementia and 225 574 controls 55 years or older matched by age, sex, general practice, and calendar time. Information on prescriptions for 56 drugs with strong anticholinergic properties was used to calculate measures of cumulative anticholinergic drug exposure. Data were analyzed from May 2016 to June 2018. The primary exposure was the total standardized daily doses (TSDDs) of anticholinergic drugs prescribed in the 1 to 11 years prior to the date of diagnosis of dementia or equivalent date in matched controls (index date). Odds ratios (ORs) for dementia associated with cumulative exposure to anticholinergic drugs, adjusted for confounding variables. Of the entire study population (284 343 case patients and matched controls), 179 365 (63.1%) were women, and the mean (SD) age of the entire population was 82.2 (6.8) years. The adjusted OR for dementia increased from 1.06 (95% CI, 1.03-1.09) in the lowest overall anticholinergic exposure category (total exposure of 1-90 TSDDs) to 1.49 (95% CI, 1.44-1.54) in the highest category (>1095 TSDDs), compared with no anticholinergic drug prescriptions in the 1 to 11 years before the index date. There were significant increases in dementia risk for the anticholinergic antidepressants (adjusted OR [AOR], 1.29; 95% CI, 1.24-1.34), antiparkinson drugs (AOR, 1.52; 95% CI, 1.16-2.00), antipsychotics (AOR, 1.70; 95% CI, 1.53-1.90), bladder antimuscarinic drugs (AOR, 1.65; 95% CI, 1.56-1.75), and antiepileptic drugs (AOR, 1.39; 95% CI, 1.22-1.57) all for more than 1095 TSDDs. Results were similar when exposures were restricted to exposure windows of 3 to 13 years (AOR, 1.46; 95% CI, 1.41-1.52) and 5 to 20 years (AOR, 1.44; 95% CI, 1.32-1.57) before the index date for more than 1095 TSDDs. Associations were stronger in cases diagnosed before the age of 80 years. The population-attributable fraction associated with total anticholinergic drug exposure during the 1 to 11 years before diagnosis was 10.3%. Exposure to several types of strong anticholinergic drugs is associated with an increased risk of dementia. These findings highlight the importance of reducing exposure to anticholinergic drugs in middle-aged and older people.

Association between anticholinergic drug prescription changes and rehabilitation outcome in post-acute hip fractured patients

Purpose: To follow changes in anticholinergic drug prescriptions throughout hip fractured patients’ rehabilitation; to assess whether a change in anticholinergic burden affects rehabilitation outcome.Methods: Retrospective study of 869 hip fractured patients admitted between January 2011 to October 2015, performed in a post-acute geriatric rehabilitation center. The Anticholinergic Cognitive Burden Scale quantified the anticholinergic burden. Main outcome measures: Functional Independence Measure, motor Functional Independence Measure, Montebello Rehabilitation Factor Score on motor Functional Independence Measure and length of stay. Multiple linear regression analysis tested for independent association between admission anticholinergic burden and anticholinergic burden change during rehabilitation, and rehabilitation outcomes.Results: One hundred and sixty two (18.7%) patients were prescribed additional anticholinergic medications upon discharge; 76 (8.7%) were prescribed fewer. Patients with high admission anticholinergic burden presented with a significantly higher rate of higher education, less likely to reside at home, less independent pre-fracture, exhibited a significantly lower admission and discharge Functional Independence Measure score, a lower Functional Independence Measure score change and a lower Montebello Rehabilitation Factor Score. Admission anticholinergic burden, but not changes in anticholinergic burden during rehabilitation, was found to be independently associated with rehabilitation outcome (discharge FIM score).Conclusions: High admission anticholinergic burden is associated with lower functional ability in hip fractured patients. Changes in anticholinergic drug prescription during rehabilitation were not associated with rehabilitation outcomes.Implications for rehabilitationClinicians should make an effort to reduce AC drug use in hip fractured patients on admission to post-acute rehabilitation.AC burden should be carefully monitored throughout the rehabilitation period and reduced whenever possible.When functional ability does not improve as expected, AC burden should be considered as an intervening factor.

Potentially inappropriate prescriptions of anticholinergic drugs in patients with benign prostatic hyperplasia

Background Prostatic hyperplasia is frequent in the elderly, and it can be associated with urinary retention in patients who use cholinergic antagonists. The objective was to estimate the anticholinergic burden of drugs prescribed to patients diagnosed with benign prostatic hyperplasia. Methods A cross-sectional study using a population database to identify prescriptions of cholinergic antagonists drugs used in the management of benign prostatic hyperplasia. The anticholinergic burden was evaluated using the Anticholinergic Drug Scale. Results Three thousand seven hundred and sixty patients with benign prostatic hyperplasia were identified, with a mean age of 68.26 ± 10.46 years. Of these patients, 2961 (78.8%) received pharmacological treatment mainly with tamsulosin monotherapy (34.7%, n = 1026). Overall, 34.7% (n = 1303) of all patients were taking cholinergic antagonists. Patients aged 75–84 years (OR: 1.985, 95%CI: 1.063–3.709) and those 85 or older (OR: 2.52, 95%CI: 1.287–4.948) had a greater probability of having an anticholinergic burden score ≥3 points. Of the patients not receiving pharmacological treatment for benign prostatic hyperplasia, 35% (n = 280) were taking medications with anticholinergic properties. Conclusions A high proportion of patients with benign prostatic hyperplasia were receiving medical management for the relief of symptoms, mostly via monotherapy. However, one-third of patients received some type of medication with anticholinergic properties, being much more frequent after 75 years.

Clozapine and Gastrointestinal Hypomotility.

Gastrointestinal hypomotility (GIH) is an under-reported but highly prevalent and potentially dangerous side effect of clozapine. In a comprehensive meta-analysis of clozapine-treated patients, the prevalence of GIH was 32%. In general, GIH has consistently been reported to have a negative impact on quality of life, and there is no reason to believe this will be different in clozapine-treated patients with therapy-resistant schizophrenia. GIH is dangerous; in a comparative review of lethal side effects of clozapine, the mortality of agranulocytosis was 2.2-4.2% compared with 15.0-27.5% for GIH. The mortality rate in our review of all published case reports of ileus was 43.7%. (Co-)Prescription of anticholinergic drugs in patients treated with clozapine should be avoided as anticholinergics are associated with increased incidence and fatality of ileus. Prevention of GIH can best be obtained by frequent and targeted questioning by the mental healthcare providers of the patients' defecation pattern and this is therefore strongly recommended for timely detection and treatment of treatment-emergent GIH throughout clozapine treatment. Treatment approaches can be either preventive laxative prescription with every clozapine prescription in all clozapine-treated patients or targeted treatment of treatment-emergent GIH. First-line treatments of GIH are the osmotic laxative macrogol, stool softener docusate and bowel stimulant senna. As the occurrence of severe cases of GIH is not restricted to a certain treatment duration, alertness for and/or treatment of GIH is required for the whole duration of clozapine treatment.

Inappropriate anticholinergic drugs prescriptions in older patients: analysing a hospital database.

Background Although many anticholinergics are inappropriate in older patients, the prescription of these drugs in a hospital setting has not been extensively studied. Objective To describe prescriptions of anticholinergic drugs in terms of frequency, at risk situations and constipation in hospitalized, older adults. Setting Using a database from a French general hospital (period 2009-2013), we extracted information on 14,090 hospital stays by patients aged 75 and over. Methods Anticholinergic drug prescriptions were automatically detected, with a focus on prescriptions in three well-known at-risk situations: falls, dementia, and benign prostatic hyperplasia. Cases of constipation that might have been causally related to the administration of anticholinergic drugs were screened for and reviewed. Main outcome measure Prescriptions with a high associated risk of anticholinergic related adverse reactions. Results Administration of an anticholinergic drug was detected in 1412 (10.0%) of the hospital stays by older patients. At-risk situations were identified in 413 (36.5%) of these stays: 137 (9.7%) for falls, 243 (17.2%) for dementia, and 114 (8.1%) for benign prostatic hyperplasia; 78 (18.9%) of these 413 stays featured a combination of two or three at-risk situations. Cases of constipation induced by anticholinergic drug administration were identified in 188 (13.3%) patient stays by using validated adjudication rules for adverse drug reactions: 85 and 103 cases were respectively evaluated as "possible" or "probable" adverse drug reactions. Conclusions Anticholinergic drugs prescription was found in 10.0% of hospitalized, older patients. More than one third of these prescriptions occurred in at-risk situations and more than one in ten prescriptions induced constipation.

Anticholinergic Risk and Frequency of Anticholinergic Drug Prescriptions in a Population Older Than 65

ObjectiveTo determine the risk and frequency of anticholinergic drug prescriptions in a population affiliated with the Colombian General System of Social Security in Health. DesignA cross-sectional study was conducted in 2013. ParticipantsPatients older than 65 years who received drugs with the potential to block cholinergic receptors, in accordance with an anticholinergic risk scale. MeasurementsThe total anticholinergic load was determined by the sum of the risk of each prescribed drug. ResultsThe study included a total of 27,654 patients with a mean age of 76.1 ± 7.6 years, and 61.9% were women. A total of 9.1% of the population older than 65 years had received a prescription of at least one of these drugs, and the prevalence of these prescriptions was 112.5 per 1000 members. The average number of drugs prescribed per patient was 1.4, and the drugs most frequently prescribed contained trazodone, methocarbamol, and loratadine. Being prescribed by practitioners of surgical or related specialties was the only variable significantly associated with prescriptions with high anticholinergic risk in the multivariate analysis (odds ratio 1.61; 95% confidence interval 1.335–1.934; P < .001). ConclusionWe found a high frequency of prescription medications with some degree of anticholinergic load, and in almost half of the patients, the anticholinergic risk score was very high. The prevalence of prescription of these drugs falls in the range of that reported globally. It is essential to educate prescribers about the risk to their patients.

Anticholinergic burden in Parkinson's disease inpatients.

Anticholinergic toxicity can arise as a result of the cumulative burden of multiple medications and metabolites rather than be caused by a single compound. In this sense, prescribing drugs with anticholinergic properties to Parkinson's disease (PD) patients could contribute to aggravate some frequent problems of the disease, like dementia, urinary retention, falls, or constipation, among others. The main purpose of this article is to measure the total anticholinergic burden in a group of PD inpatients. We analyzed information from different administrative Basque Country's healthcare databases using encrypted unique identifiers in order to detect PD patients admitted to public acute care hospital during 2011-2012. Subsequently, anticholinergic burden was measured using Duran et al.'s list. Secondarily, total anticholinergic load was assessed with the Anticholinergic Drug Scale, the Anticholinergic Risk Score, and the Anticholinergic Burden Scale. A logistic regression model was performed to study association of predictive variables with anticholinergic use. A high proportion of PD patients were prescribed anticholinergic drugs, with 53.6% of admissions receiving at least one drug from Duran et al.'s "low-risk" and 10% at least "high-risk" drug. Drugs used for non-motor symptoms and other comorbidities other than PD itself contributed significantly to anticholinergic burden, namely antidepressants, antipsychotics, urological drugs, analgesics, and antihistamines, among others. The total number of drugs and cholinesterase inhibitors were independently associated with anticholinergic drug use. Anticholinergic burden in PD patients is significant, and is caused mostly by drugs not used for PD motor symptoms. Polypharmacy and cholinesterase inhibitors were independently associated with anticholinergic drug prescriptions.

Drug-Induced Acute Urinary Retention #287

Journal of Palliative MedicineVol. 18, No. 2 Fast Facts and ConceptsDrug-Induced Acute Urinary Retention #287Winifred TeutebergWinifred TeutebergSearch for more papers by this authorPublished Online:26 Jan 2015https://doi.org/10.1089/jpm.2015.1010AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Drug-Induced Acute Urinary Retention #287." Journal of Palliative Medicine, 18(2), pp. 187–188FiguresReferencesRelatedDetailsCited ByPotentially inappropriate prescriptions of anticholinergic drugs in patients with benign prostatic hyperplasia6 April 2019 | The Aging Male, Vol. 23, No. 5Bladder Care in Palliative Care Inpatients: A Prospective Dual Site Cohort Study Riona Pais, Philip Lee, Shamira Cross, Val Gebski, and Rajesh Aggarwal30 October 2020 | Palliative Medicine Reports, Vol. 1, No. 1 Volume 18Issue 2Feb 2015 InformationCopyright 2015, Mary Ann Liebert, Inc.To cite this article:Winifred Teuteberg.Drug-Induced Acute Urinary Retention #287.Journal of Palliative Medicine.Feb 2015.187-188.http://doi.org/10.1089/jpm.2015.1010Published in Volume: 18 Issue 2: January 26, 2015PDF download

Prevalence and Predictors of Anticholinergic Agents in Elderly Outpatients with Dementia

Background Anticholinergic medications, although frequently used in elderly populations, are associated with cognitive impairment and constitute significant concern for patients with dementia. Objective The purpose of our study was to examine patterns and predictors of prescribing anticholinergic agents for elderly outpatients with dementia. Methods We combined data from the 2006–2007 National Ambulatory Medical Care Survey and the outpatient department component of National Hospital Ambulatory Medical Care Survey to analyze patient visits by elderly persons (aged ≥65 years) with dementia. Anticholinergic drugs were identified using the Anticholinergic Drug Scale, which classifies anticholinergic drugs into four levels (0–3) in increasing order of anticholinergic activity. Descriptive analysis using sampling weights was used to evaluate patterns of anticholinergic drug prescription, especially prescribing of medications with clinically significant anticholinergic activity (ie, levels 2 or 3). Multiple logistic regression was used in the conceptual framework of the Andersen Behavioral Model to examine the predisposing, enabling, and need factors associated with prescribing of medications with clinically significant anticholinergic activity. Results According to the national surveys there were a total of 6.8 million (95% CI, 5.27–8.44 million; 0.32%) ambulatory care visits for dementia. Approximately 43% (42.86%; 95% CI, 35.24–50.48) of these visits involved prescribing at least one anticholinergic drug; and 10.07% of visits involved prescribing levels 2 or 3 anticholinergic medications. The predisposing factor, age (75–84 years; odds ratio [OR] = 0.25; 95% CI, 0.07–0.87), and the need factors, acetylcholinesterase inhibitor use (OR = 0.25; 95% CI, 0.07–0.86) and comorbid mood disorders (OR = 0.12; 95% CI, 0.02–0.73), were associated with decreased likelihood of prescribing medications with clinically significant anticholinergic activity. The need factor total number of medications prescribed (OR = 1.45, 95% CI, 1.20–1.75) increased the likelihood of these prescriptions being administered. Conclusions One in 10 outpatient visits by elderly persons with dementia involved prescribing medications with clinically significant anticholinergic activity. Given their adverse cognitive effects, there is a strong need to optimize anticholinergic drug prescribing in vulnerable elderly outpatients with dementia.

Effects of Anticholinergic Drugs on Cognitive Function in Older Australians: Results from the AIBL Study

Background/Aims: The nature and extent of adverse cognitive effects due to the prescription of anticholinergic drugs in older people with and without dementia is unclear. Methods: We calculated the anticholinergic load (ACL) of medications taken by participants of the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of ageing, a cohort of 211 Alzheimer’s disease (AD) patients, 133 mild cognitive impairment (MCI) patients and 768 healthy controls (HC) all aged over 60 years. The association between ACL and cognitive function was examined for each diagnostic group (HC, MCI, AD). Results: A high ACL within the HC group was associated with significantly slower response speeds for the Stroop color and incongruent trials. No other significant relationships between ACL and cognition were noted. Conclusion: In this large cohort, prescribed anticholinergic drugs appeared to have modest effects upon psychomotor speed and executive function, but not on other areas of cognition in healthy older adults.

Anticholinergic drug use for overactive bladder in Sweden: a nationwide pharmacoepidemiological study

Nationwide use and costs of anticholinergic drug for overactive bladder are unknown. We performed a nationwide study based on the Swedish Register on Prescribed Pharmaceuticals. From 2000 to 2007, there was a 68.8% increase in dispensed anticholinergic drugs in a population of 9 million. More than 93 million DDDs (calculated average maintenance dose per day) of anticholinergic drugs were dispensed corresponding to an overall DDD/TID (DDD per 1,000 inhabitants per day) of 3.5 per 1,000 persons per year. Approximately two thirds of anticholinergic drugs were prescribed to women, regardless of drug type. In 2007, the cost for anticholinergic drugs was 22 million <euro> of which tolterodine comprised 70.8%. Solifenacin and darifenacin steadily increased their DDD/TIDs after market introduction. In this nationwide study, there was a 70% increased rate of expedited prescriptions of anticholinergic drugs for the treatment of overactive bladder in a relatively stable population.