Prevalence Of Anticholinergic Use Research Articles

Increasing prevalence of anticholinergic medication use in older people in England over 20\u2009years: cognitive function and ageing study I and II

BackgroundAnticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability.MethodsWe compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990–1993 (N = 7635) and 2008–2011 (N = 7762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score = 3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability.ResultsPrevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2–6.3%) of the older population in 1990–93 to 9.9% (9.3–10.7%) in 2008–11, adjusted odds ratio of 1.90 (95% CI 1.67–2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergics in CFAS II (16.5% [95% CI 12.0–22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II).ConclusionsUse of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.

Anticholinergic burden in the Japanese elderly population: Use of antimuscarinic medications for overactive bladder patients.

To assess anticholinergic use, especially the use of antimuscarinics, in the elderly (aged ≥65years) Japanese overactive bladder and non-overactive bladder populations. Patient records were sourced from a large, nationwide Japanese pharmacy claims database. Anticholinergic use on a random day in 2016 (index date) was investigated through the Anticholinergic Cognitive Burden scale (primary scale), the Anticholinergic Drug Scale, the Anticholinergic Risk Scale and Beers criteria. The prevalence of anticholinergic use and anticholinergic scores at the index date were summarized descriptively. The overactive bladder population was defined as patients who had at least one prescription record for any antimuscarinic (fesoterodine, imidafenacin, oxybutynin, propiverine, solifenacin or tolterodine) or the β3-adrenoreceptor agonist, mirabegron, within the 1-year pre-index period. Among 1216126 outpatients, 35138 (2.9%) were included in the overactive bladder group. In total, 112 (68.7%) of the anticholinergics listed in the scales were identified. In those who received any Anticholinergic Cognitive Burden scale-listed anticholinergic, the mean scores were higher in overactive bladder patients versus non-overactive bladder patients (3.2±1.3 and 1.6±1.1, respectively). Similarly, overactive bladder patients who received antimuscarinics had higher Anticholinergic Cognitive Burden scores (3.3±1.2) than patients who received mirabegron only (1.7±1.1). In 58.8% of the overactive bladder patients, ≥80% of the total Anticholinergic Cognitive Burden score was exclusively attributable to antimuscarinics. Anticholinergic use was higher in overactive bladder patients versus non-overactive bladder patients. This increased use was largely attributable to antimuscarinics. The alternative use of mirabegron could therefore be considered to reduce the burden experienced by patients in Japan.

Anticholinergic Exposure in a Cohort of Adults Aged 80 years and Over: Associations of the MARANTE Scale with Mortality and Hospitalization.

Anticholinergics are frequently prescribed for older adults and can lead to adverse drug events. The novel MARANTE (Muscarinic Acetylcholinergic Receptor ANTagonist Exposure) scale measures the anticholinergic exposure by incorporating potency and dosages of each medication into its calculations. The aims were to assess prevalence and intensity of the anticholinergic exposure in a longitudinal cohort study of community-dwelling patients aged 80years and over (n=503) and to study the impact on mortality and hospitalization. Chronic medication use at baseline (November 2008-September 2009) was entered and codified with the Anatomical Therapeutic Chemical classification. Time-to-event analysis until first hospitalization or death was performed at 18months after inclusion, using Kaplan-Meier curves. Cox regression was performed to control for covariates. Mean age was 84years (range 80-102), and mean number of medications was 5 (range 0-16). Prevalence of anticholinergic use was 31.8%, with 9% taking ≥2 anticholinergics (range 0-4). Main indications for anticholinergics were depression, pain and gastric dysfunction. Female gender, the level of multi-morbidity and the number of medications were associated with anticholinergic use. Mortality and hospitalization rate were 8.9% and 31.0%, respectively. After adjustment for the level of multi-morbidity and medication intake, multi-variable analysis showed increased risks of mortality (HR 2.3, 95% CI: 1.07-4.78) and hospitalization (HR 1.7; 95% CI: 1.13-2.59) in those with high anticholinergic exposure. The longitudinal study among Belgian community-dwelling oldest old demonstrated great anticholinergic exposure, which was associated with increased risk of mortality and hospitalization after 18months.

High-Dose Anticholinergic Drugs May Increase Dementia Risk

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessHigh-Dose Anticholinergic Drugs May Increase Dementia RiskVabren WattsVabren WattsSearch for more papers by this authorPublished Online:3 Apr 2015https://doi.org/10.1176/appi.pn.2015.3a15AbstractBecause of risk related to cognitive impairment associated with use of anticholinergics, some geriatric psychiatry experts are recommending that other therapeutic options be considered.Previous studies have suggested that medications—both prescription and over the counter—aiming to block the actions of acetylcholine may be associated with increased risk for cognitive impairment, but a recent study published in JAMA Internal Medicine shows that use of such medicines in older adults may increase the risk for dementia.Dragon Images/ShutterstockResearchers from the Geriatric Pharmacy Program at the University of Washington led a large-scale study with older adults to examine whether a correlation exists between cumulative anticholinergic drug use and the onset of dementia.“There are many medications with anticholinergic properties that impair cognitive performance,” said Davangere Devanand, M.D., director of the Division of Geriatric Psychiatry at the New York State Psychiatric Institute, who was not involved in the study. “Recognizing the cognitive impact of anticholinergic medications is very important for the well-being of patients,” he told Psychiatric News.According to the study, medications with anticholinergic activity are widely used by older adults for an array of conditions, including overactive bladder, seasonal allergies, and depression. Previous studies have shown that the prevalence of anticholinergic use in older adults ranges from 8 percent to 37 percent. To ascertain patients’ cumulative anticholinergic exposure, the researchers analyzed 10 years of pharmacy-dispensing data on 3,400 individuals aged 65 and older who had no history of dementia at the study’s initiation. The results showed that individuals taking daily dosages of at least 10 mgs of tricyclic antidepressants, 4 mgs of first-generation antihistamines, or 5 mgs of antimuscarinics for bladder control for more than three years were at greater risk for developing dementia than their counterparts who did not use such medicines long term.The researchers noted that the study highlights the need to increase awareness among health care professionals and older adults about the potential risk associated with extended use of anticholinergic drugs as well as a need for efforts to minimize such drug use. “Older adults should be aware that many medications—including some available without a prescription, such as over-the-counter sleep aids—have strong anticholinergic effects,” said the study’s lead author, Shelly Gray, Pharm.D., M.S., director of the geriatric pharmacy program. “If providers need to prescribe a medication with anticholinergic effects because it is the best therapy for their patient,” Gray stated, “they should use the lowest effective dose, monitor the therapy regularly to ensure it’s working, and stop the therapy if it’s ineffective.” “Physicians prescribing anticholinergics need to monitor the medicines’ impact on patients’ cognitive abilities and, consequently, functional abilities,” said Devanand. Measuring such abilities, he suggested, can be achieved by open-ended questioning of patients and caregivers and by serial administration of brief cognitive assessments such as the Mini-Mental State Examination and the Montreal Cognitive Assessment.As for Gray and colleagues, she said that future studies with postmortem brain tissue are under way. The researchers plan to investigate differences, if any, of dementia-related pathology between brains that were exposed long term to anticholenergic drugs and those that were not. The study was funded by the National Institute on Aging. ■An abstract of “Cumulative Use of Strong Anticholinergics and Incident Dementia” can be accessed here. ISSUES NewArchived

Prevalence of anticholinergic use among older home health patients

Prevalence of anticholinergic use among older home health patients

Evaluation of a Web-Based Tool in Screening for Medication-Related Problems in Community-Dwelling Older Adults

The primary objective was to evaluate the effectiveness of a Web-based program, Monitor-Rx, in identifying older adults at risk for drug-related geriatric syndromes or inappropriate medicines. This prospective pilot study compared medication related risks generated by the Web-based program with those identified by a certified geriatric pharmacist (CGP). Wisconsin-based community pharmacy serving primarily older adults. 29 community-dwelling older adults (mean age: 81.6 years, mean daily medications: 11.7). Each participant received a complete medication history, including self-identified geriatric syndromes. Each participant's demographic information and medications were entered into Monitor-Rx and concurrently reviewed by a CGP. Number of potentially inappropriate medications (PIMs), anticholinergic medicines, and identified geriatric syndromes. All participants were identified as at risk for falls by Monitor-Rx and the CGP. Significant medication-related risks identified were urinary incontinence, cognition/memory, nutrition, and dental care. Monitor-Rx identified more participants at risk for geriatric syndromes than the CGP; however, PIMs were identified more frequently by the CGP. Twenty-six participants self-identified at least one geriatric syndrome. Prevalence of anticholinergic use was more than 75%. In the participants screened, Monitor-Rx was successful at identifying those with a high risk of drug-related geriatric syndromes. An interview was also important to clarify use of the PIM and to identify whether at-risk participants were actually experiencing the drug related geriatric syndromes. Use of the Web-based tool does not supplant the experience of a well-trained geriatric pharmacist and the professional judgment that comes with that experience.

Antipsychotic and Anticholinergic Drug Prescribing Pattern in Psychiatry: Extent of Evidence-Based Practice in Bahrain

The aim of this study is to determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing in a psychiatric referral hospital. A retrospective audit of prescriptions issued for outpatients was carried out at the Psychiatric Hospital, the only facility that provides psychiatric services for both inpatients and outpatients in the Kingdom of Bahrain. Antipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two- and three-drugs in 10.4 and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalent (CPZeq; mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq > 1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy), mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%; poly-therapy 87.5%). Antipsychotic polytherapy, high dose and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics. In Bahrain, antipsychotic monotherapy is a common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.

P03-52 - Antipsychotic and anticholinergic drug prescribing pattern in psychiatry:Implications for evidence - based practice

ObjectivesTo determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing for patients with psychotic disorders.MethodsA retrospective audit of prescriptions issued for outpatients at the Psychiatric Hospital in Bahrain.ResultsAntipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two- and three- drugs in 10.4 and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Majority of the study population (93.2%) were prescribed an oral antipsychotic, whereas 3.1% each were on depot preparation or on depot plus an oral antipsychotic. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalents (CPZeq; mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq>1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy) mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%; polytherapy 87.5%). Antipsychotic polytherapy, high dose of antipsychotics and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics.ConclusionAntipsychotic monotherapy is the common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.

The Concurrent Use of Anticholinergics and Cholinesterase Inhibitors: Rare Event or Common Practice?

To measure the prevalence of anticholinergic use cross-sectionally in patients receiving cholinesterase inhibitors and to describe change in use of anticholinergics upon inception of cholinesterase inhibitor treatment. Cross-sectional and inception cohort studies. State of Iowa. Iowa Medicaid beneficiaries aged 50 and older with a pharmacy claim for a cholinesterase inhibitor during January 1997 through February 2000. Anticholinergic use was determined for all patients with a cholinesterase inhibitor pharmacy claim during January and February of 2000. A frequency distribution of all anticholinergics was compiled, with emphasis placed on those considered inappropriate in the elderly. In a separate analysis, anticholinergic use was determined at two points: 90 days before and after cholinesterase inhibitor inception. Of 557 patients receiving a cholinesterase inhibitor, 197 (35.4%) received an anticholinergic concurrently. Of all anticholinergics, 74.5% (178/239) had been identified as inappropriate for use in the elderly, 22.2% (53/239) under any circumstances. At the time of cholinesterase inhibitor inception, 30.2% (143/474) and 33.5% (159/474) of patients received an anticholinergic 90 days before and 90 days after inception, respectively. Increases in anticholinergic prescribing upon cholinesterase inhibitor inception exceeded decreases (Wilcoxon signed-rank test, S=529, P=.020). The concurrent use of anticholinergics and cholinesterase inhibitors is common although rarely appropriate. Patients with Alzheimer's disease deserve to receive the optimum benefit from cholinesterase inhibitor treatment, which can only be achieved through diligent and appropriate use of concurrent pharmacotherapy.