Potentially Inappropriate Prescriptions for Anticholinergic Medications for Patients with Constipation

2020 ◽  
Vol 38 (6) ◽  
pp. 500-506
Author(s):  
Luis Fernando Valladales-Restrepo ◽  
Milton Paredes-Mendoza ◽  
Jorge Enrique Machado-Alba
Keyword(s):  
Anticholinergic Drug ◽  
Gastrointestinal Disorder ◽  
Cholinergic Antagonists ◽  
Outpatient Services ◽  
Population Database ◽  
Cross Sectional ◽  
Anticholinergic Medications ◽  
Cholinergic Antagonist ◽  
Anticholinergic Burden ◽  
Inappropriate Prescriptions

<b><i>Introduction:</i></b> Constipation is a very common functional gastrointestinal disorder in the general population and can be primary or secondary. <b><i>Objective:</i></b> The aim of this study was to estimate the anticholinergic burden of prescribed drugs in a population diagnosed with constipation in Colombia. <b><i>Methods:</i></b> This was a cross-sectional study that used a population database of 6.5 million people to identify the prescription of cholinergic antagonists and drugs for the management of constipation in outpatient services. The anticholinergic burden was evaluated using the Anticholinergic Drug Scale. Potentially inappropriate prescriptions that increased the risk of constipation were identified. <b><i>Results:</i></b> A total of 3,887 patients with constipation were identified; the identified patients had a mean age of 54.4 ± 21.9 years, and 69.4% were women. Eighty percent received at least one laxative, and the most prescribed laxative was bisacodyl (50.5%). Forty-one percent (<i>n</i> = 1,586) of all patients received drugs with cholinergic antagonist activity, in particular codeine (6.5%) and valproic acid (6.5%). Being over 30 years of age (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.24–2.57), being treated in the cities of Manizales (OR: 2.20; 95% CI: 1.50–3.21) and Pereira (OR: 1.49; 95% CI: 1.07–2.09), and having hypothyroidism as a comorbidity (OR: 1.37; 95% CI: 1.08–1.73) were associated with a greater probability of receiving medications with an anticholinergic burden of 3 or more points. <b><i>Conclusions:</i></b> The majority of patients with constipation were women and were using laxatives to manage constipation. A large proportion of patients were prescribed at least one cholinergic antagonist drug, with an increased probability of use after 30 years of age.

scholarly journals Prescribing Trends of Anticholinergic Drugs Between 1989 and 2017: A UK Biobank Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 209-209
Author(s):  
Jure Mur ◽  
Simon Cox ◽  
Riccardo Marioni ◽  
Tom Russ ◽  
Graciela Muniz Terrera
Keyword(s):  
Prescription Drugs ◽  
Anticholinergic Drug ◽  
Later Life ◽  
Anticholinergic Drugs ◽  
Uk Biobank ◽  
Linear Estimate ◽  
Cross Sectional ◽  
Increased Risk ◽  
Prescribing Trends ◽  
Anticholinergic Burden

Abstract Prescription drugs with anticholinergic properties are commonly prescribed and negatively impact physical performance, cognitive function, and increase the risk of falls and dementia. The prevalence of anticholinergic drugs is high in later life, when there is an increased risk of adverse drug effects. Recent, in-depth longitudinal analyses of specifically anticholinergic prescribing in Europe is lacking. Prescriptions for the UK-Biobank participants (n=222,122) were ascertained from primary care electronic patient records. We assigned anticholinergic activity to each drug by using a composite score. We used linear regression to study the association between current anticholinergic burden and time period, explore secular trends in anticholinergic use, and various demographic factors. We further explored the results in the context of different classes of prescriptions drugs. 74 distinct drugs in the sample (1.1%) had anticholinergic effects. An individual’s overall anticholinergic burden increased nonlinearly (linear estimate=0.474, quadratic estimate = 0.094, both p&lt;2.2x10-16) between 1989 (mean=0.09, σ=0.009) and 2000 (mean=0.22, σ=0.006) and increased nonlinearly (linear estimate=0.282, quadratic estimate=0.074, both p&lt;2.2x10-16) from 2000 to 2016 (mean=0.27, σ=0.009). The proportion of patients prescribed at least one anticholinergic drug per month increased from 6.1% to 16.7% from 1989 to 2000 and increased to 18.6% by 2016. When adjusted for sex and polypharmacy, age was negatively associated with recent cross-sectional anticholinergic burden (estimate=-0.042, p&lt;2.2x10-16). Our results demonstrate an increase in prescribing of anticholinergic drugs over the past 30 years and indicate contemporary deprescribing of anticholinergic drugs in the later decades of life.

Anticholinergic Medication Burden in Parkinson’s Disease Outpatients

2021 ◽  
pp. 1-8
Author(s):  
Huma Nawaz ◽  
Lana Sargent ◽  
Helengrace Quilon ◽  
Leslie J. Cloud ◽  
Claudia M. Testa ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cholinesterase Inhibitors ◽  
Anticholinergic Drug ◽  
Weighted Kappa ◽  
Anticholinergic Medication ◽  
Anticholinergic Medications ◽  
Drug Classes ◽  
Highly Correlated ◽  
Anticholinergic Burden

Background: Individuals with Parkinson’s disease (PD) may be especially vulnerable to future cognitive decline from anticholinergic medications. Objective: To characterize anticholinergic medication burden, determine the co-occurrence of anticholinergic and cholinesterase inhibitors, and to assess the correlations among anticholinergic burden scales in PD outpatients. Methods: We studied 670 PD outpatients enrolled in a clinic registry between 2012 and 2020. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Drug Burden Index-Anticholinergic component (DBI-Ach). Correlations between scales were assessed with weighted kappa coefficients. Results: Between 31.5 to 46.3% of PD patients were taking medications with anticholinergic properties. Among the scales applied, the ACB produced the highest prevalence of medications with anticholinergic properties (46.3%). Considering only medications with definite anticholinergic activity (scores of 2 or 3 on ACB, ADS, or ARS), the most common anticholinergic drug classes were antiparkinsonian (8.2%), antipsychotic (6.4%), and urological (3.3%) medications. Cholinesterase inhibitors and medications with anticholinergic properties were co-prescribed to 5.4% of the total cohort. The most highly correlated scales were ACB and ADS (κ= 0.71), ACB and ARS (κ= 0.67), and ADS and ARS (κ= 0.55). Conclusion: A high proportion of PD patients (20%) were either taking antiparkinsonian, urological, or antipsychotic anticholinergic medications or were co-prescribed anticholinergic medications and cholinesterase inhibitors. By virtue of its detection of a high prevalence of anticholinergic medication usage and its high correlation with other scales, our data support use of the ACB scale to assess anticholinergic burden in PD patients.

scholarly journals A SIMPLE INTERVENTION TO REDUCE ANTICHOLINERGIC DRUG USE WHILE ATTENDING A GERIATRIC DAY HOSPITAL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S708-S709
Author(s):  
Costa Apostolides
Keyword(s):  
Anticholinergic Drug ◽  
Intervention Group ◽  
Control Group ◽  
Day Hospital ◽  
Patient Chart ◽  
Drug Burden Index ◽  
Anticholinergic Medications ◽  
The Mean ◽  
Anticholinergic Burden ◽  
Beneficial Outcome

Abstract Attendance at a Geriatric Day Hospital has previously been shown to reduce both the overall number of medications and the number of anticholinergic medications of patients. In the present study, patients enrolled in a Geriatric Day Hospital program from January to February 2019 were divided into a control and intervention group. Anticholinergic medications in the intervention group were flagged by highlighting them in the patient chart and alerting the attending clinician, whereas no alerts were provided in the control group. Anticholinergic load was calculated using the Anticholinergic Cognitive Burden (ACB) and Drug Burden Index (DBI) scores. In comparing admit versus discharge medications in the intervention group, both the mean number of overall medications (10 vs. 9.7) and anticholinergic medications (3.5 vs. 3.1) was reduced; this was not the case in the control group, where the mean number of overall medications remained the same (11.92) and the mean number of anticholinergic medications increased (3.83 vs. 3.92). More significantly, in comparing admit versus discharge scores, both the mean ACB and DBI scores were reduced in the intervention group, but in the control group both the ACB and DBI scores either remained the same or increased at the time of discharge. This clearly shows that a simple intervention (highlighting anticholinergic medications in the patient chart) can have a clinically beneficial outcome of reducing these harmful medications in patients. With approximately 50% of the older population taking at least one anticholinergic drug, the importance of reducing anticholinergic burden cannot be overemphasized.

scholarly journals Anti-Cholinergic Drug Burden Among Ambulatory Elderly Patients in a Nigerian Tertiary Healthcare Facility

2021 ◽  
Vol 12 ◽  
Author(s):  
Joseph O. Fadare ◽  
Abimbola Margaret Obimakinde ◽  
Felix O. Aina ◽  
Ebisola J. Araromi ◽  
Theophilus Adekunle Adegbuyi ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Anticholinergic Drug ◽  
Healthcare Facility ◽  
The Elderly ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Cross Sectional ◽  
Anticholinergic Effects ◽  
Tertiary Healthcare ◽  
Anticholinergic Burden

Background: The use of drugs with anticholinergic effects among elderly patients is associated with adverse clinical outcomes. There is paucity of information about anticholinergic drug burden among Nigerian elderly population.Objectives: To determine the anticholinergic drug burden among elderly Nigerian patients.Methods: This was a retrospective cross-sectional study conducted among elderly patients (aged 65 and above) who visited the Family Medicine outpatients’ clinics of the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria between July 1 and October 31, 2018. Information extracted from the case files included patient’s age, sex, diagnoses, and list of prescribed medications. Medicines with anticholinergic effects were identified and scored using the anticholinergic drug burden calculator (http://www.acbcalc.com).Results: The medical records of 400 patients were analyzed with females accounting for 60.5% of the study population. The mean age of participants was 73 ± 7.4 years with only 28 (7%) of patients having more than two co-morbid conditions. Polypharmacy was identified in 152 (38%) of the patients while 147 (36.7%) had drugs with anticholinergic effects prescribed. The anticholinergic burden was high in 60 (15%) patients. Polypharmacy was significantly associated with having more than two diagnosed conditions and high anticholinergic burden (p value of &lt; 0 .001 and 0.013 respectively). There was significant correlation between total number of prescribed drugs and count of diagnoses (r = 0.598; p &lt; 0 .000) and between total number of prescribed drugs and number of drugs with anticholinergic effects (r = 0 .196; p &lt; 0 .000).Conclusion: The anticholinergic burden in this group of elderly Nigerian patients was low; majority (67%) had no exposure to drugs with anticholinergic effects with only 15% having high anticholinergic burden. Polypharmacy and multiple diagnosed conditions were positively associated with high anticholinergic burden. Based on the positive and significant correlations found in this study, a reduction in the number of prescribed medicines especially those with significant anticholinergic effects used for secondary indications may lessen the anticholinergic burden among the elderly.

scholarly journals Potentially Inappropriate Prescriptions of Antipsychotics for Patients With Dementia

2021 ◽  
Vol 12 ◽  
Author(s):  
Manuel Enrique Machado-Duque ◽  
Luis Fernando Valladales-Restrepo ◽  
Juan Alberto Ospina-Cano ◽  
María José Londoño-Serna ◽  
Jorge Enrique Machado-Alba
Keyword(s):  
Psychotic Disorders ◽  
Cross Sectional Study ◽  
Population Database ◽  
Cross Sectional ◽  
Antidementia Drugs ◽  
Diagnosis Of Dementia ◽  
The Central Nervous System ◽  
The Mean ◽  
Anxiety Depression ◽  
Inappropriate Prescriptions

Dementias are neurodegenerative and progressive diseases of the central nervous system. The objective of this study was to determine the frequency of potentially inappropriate prescriptions of antipsychotics in a group of patients diagnosed with dementia in Colombia. This was a cross-sectional study based on a population database for drug dispensing that identified prescriptions of antidementia drugs, antipsychotics, and other drugs for patients with a diagnosis of dementia. Descriptive statistics and bivariate and multivariate analyses were performed. A total of 11,372 patients with dementia were identified; 66.6% were women, and the mean age was 80.5 ± 9.6 years. Alzheimer’s disease was the most frequent diagnosis (76.6%). A total of 69.0% of patients received antidementia drugs. A total of 37.1% of patients received some antipsychotic, especially atypical antipsychotics (31.0%). Increased age, being treated with memantine, simultaneously presenting with anxiety, depression, and psychotic disorders, and concomitantly receiving anticonvulsants, bronchodilators and benzodiazepines were associated with a greater probability of being prescribed antipsychotics. More than one-third of patients with dementia received antipsychotic prescriptions, which are considered potentially inappropriate because they can worsen cognitive decline and favor the occurrence of adverse events.

scholarly journals Anticholinergic burden and most common anticholinergic-acting medicines in older general practice patients

2018 ◽  
Vol 57 (3) ◽  
pp. 140-147 ◽  
Author(s):  
Eva Gorup ◽  
Janez Rifel ◽  
Marija Petek šter
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
General Practice ◽  
Cross Sectional Study ◽  
Ambulatory Setting ◽  
Anticholinergic Medication ◽  
Cross Sectional ◽  
Primary Care Population ◽  
Anticholinergic Medications ◽  
Anticholinergic Burden

AbstractIntroductionAnticholinergic burden in older adults has been correlated with cognitive decline, delirium, dizziness and confusion, falls and hospitalisations. Nevertheless, anticholinergic-acting medications remain commonly prescribed in up to a third of older adults in primary care population. Our aim was to study the anticholinergic burden in older adults in Slovenian ambulatory setting and explore the most commonly involved medications which could be avoided by the physicians.MethodsA cross-sectional study was conducted in 30 general practices in Slovenia as part of a larger trial. Data on prescribed medications were collected for randomly chosen adults of over 65 years of age visiting general practice, who were taking at least one regularly prescribed medication. Anticholinergic burden was calculated using Duran’s scale and Drug Burden Index.ResultsAltogether, 622 patients were included, 356 (57.2%) female, average age of 77.2 (±6.2), with an average of 5.6 medications. At least one anticholinergic medication was present in 78 (12.5 %) patients. More than half (N=41, 52.6%) of anticholinergic prescriptions were psychotropic medications. Most common individual medications were diazepam (N=10, 1.6%), quetiapine (N=9, 1.4%) and ranitidine (N=8, 1.3%).ConclusionsThough the prevalence of anticholinergic medications was low compared to international research, the most commonly registered anticholinergic prescriptions were medications that should be avoided according to guidelines of elderly prescriptions. It would be probably clinically feasible to further decrease the anticholinergic burden of older adults in Slovenian primary care setting by avoiding or replacing these medications with safer alternatives.

scholarly journals Higher anticholinergic burden from medications is associated with significant increase in markers of inflammation in the EPIC-Norfolk prospective population-based cohort study

2021 ◽  
Author(s):  
RIA SANGHAVI ◽  
Tiberiu Pana ◽  
Hulkar Mamayusuppova ◽  
Ian Maidment ◽  
Chris Fox ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Population Based ◽  
Adverse Outcomes ◽  
Necrosis Factor Alpha ◽  
Cross Sectional ◽  
Anticholinergic Medications ◽  
Markers Of Inflammation ◽  
Increased Risk ◽  
Tnf Α ◽  
Anticholinergic Burden

Background: Higher anticholinergic burden from medications is associated with increased risk of cardiovascular disease and cognitive function decline. A mechanistic pathway has never been established. We aimed to determine whether chronic inflammation may mediate these associations. Methods: Participants were drawn from the European Prospective Investigation into Cancer, Norfolk cohort (40-79 years at baseline). The anticholinergic cognitive burden score (ACB) was calculated at baseline/first (1HC) (1993/97) and second (2HC) (1998/2000) health checks. Plasma fibrinogen and C-reactive protein (CRP) were measured during 1HC and Tumour Necrosis Factor alpha (TNF-α) and interleukin 6 (IL-6) during 2HC. Cross-sectional associations between ACB and inflammatory markers were examined for 1HC and 2HC, respectively. The prospective association was also examined between 1HC ACB and 2HC inflammatory markers. All models adjusted for age, sex, lifestyle factors, co-morbidities and medications. Results: 17,678 and 22,051 participants were included in cross-sectional analyses for CRP, and fibrinogen, respectively. A total of 5,101 participants with available data for TNF-α and IL-6 were included in the longitudinal analyses. Cross-sectionally, a point increase in the ACB was associated with a significant increase in all inflammatory markers (beta (standard error): fibrinogen – 0.035g/l (0.006), p<0.001; CRP 0.284mg/l (0.044), p<0.001; TNF-α 0.031pg/ml (0.010), p=0.002; and IL-6 0.112pg/ml (0.033), p=0.001. Longitudinally, a unit increase in the ACB was associated with a significant increase in TNF-α 0.028pg/ml (0.011), p=0.013 and IL-6 0.076 pg/ml (0.035), p=0.029. Conclusion: Higher anticholinergic burden was significantly associated with higher inflammatory markers. Inflammation may mediate the relationship between exposure to anticholinergic medications and adverse outcomes

scholarly journals Impact of anticholinergic burden on cognitive impairment, disability and malnutrition: a cross-sectional study among hospitalized older patients

2019 ◽  
Vol 5 (2) ◽  
Author(s):  
Mariapaola Nastri ◽  
Giulio Bartoli ◽  
Paolo De Colle
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Rating Scale ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Cross Sectional Study ◽  
Cognitive Status ◽  
Cross Sectional ◽  
Anticholinergic Medications ◽  
Anticholinergic Burden

The anticholinergic burden (ACB) is known to be associated with the worsening of functional and cognitive status. This study aims at demonstrating a correlation between the ACB and the malnutrition, given the widespread effect on the digestive tract of anticholinergic medications. From 2012 to 2018, 2843 patients were recruited among the new admissions to our Geriatric Unit. For each patient the activities of daily living (ADL), the instrumental activities of daily living (IADL), the mini mental state examination (MMSE), the cumulative illness rating scale (CIRS), the mini nutritional assessment (MNA) and the ACB of medications were evaluated. The correlations between the ACB and the ADL (P<0.001), the IADL (P<0.001), the MMSE (P<0.001) scores were confirmed, and a significant correlation was also found between the ACB and the MNA (P<0.001) score. The CIRS and the ACB scores resulted to be independent predictors of all outcomes considered, in a linear regression model adjusted for age, sex, comorbidity and number of prescribed drugs. Therefore, ACB seems to have by itself an impact on physical and cognitive functions and on nutritional status.

Potentially inappropriate prescriptions of antipsychotic and anticholinergic drugs in patients with Parkinson's disease

2021 ◽  
Author(s):  
Luis Fernando Valladales-Restrepo ◽  
Nathalia Marcela Peña-Verjan ◽  
Katherine Vargas-Díaz ◽  
Jorge Enrique Machado-Alba
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Psychiatric Disorders ◽  
Cross Sectional Study ◽  
Older Age ◽  
Anticholinergic Drugs ◽  
Sectional Study ◽  
Cross Sectional ◽  
Anticholinergic Burden ◽  
Inappropriate Prescriptions

Aim: The objective was to determine the prevalence of the potentially inappropriate antipsychotics and anticholinergics used in patients with Parkinson's disease. Materials & methods: A cross-sectional study identified the prescription of antipsychotics, anticholinergics and drugs for the treatment of Parkinson's disease. The anticholinergic burden was evaluated, and quetiapine and clozapine were considered to be adequate antipsychotics. Results: 2965 patients with Parkinson's disease were identified. The presence of psychiatric disorders and other neurological pathologies was associated with a greater probability of receiving potentially inappropriate antipsychotic prescriptions. The presence of greater number of comorbidities was associated with a greater probability of receiving anticholinergics. Conclusion: Older age and associated comorbidities, especially psychiatric and neurological comorbidities, increase the likelihood of patients with Parkinson's disease being prescribed antipsychotics and anticholinergics.

scholarly journals Anticholinergic Drug Induced Cognitive and Physical Impairment: Results from the InCHIANTI Study

2018 ◽  
Vol 75 (5) ◽  
pp. 995-1002 ◽  
Author(s):  
Lana Sargent ◽  
Mike Nalls ◽  
Elaine J Amella ◽  
Martina Mueller ◽  
Sarah K Lageman ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Anticholinergic Drug ◽  
Gradient Boosting ◽  
Physical Impairment ◽  
Physical Frailty ◽  
Cross Sectional ◽  
Cognitive Frailty ◽  
Physical Decline ◽  
Anticholinergic Medications ◽  
Extreme Gradient Boosting

Abstract Background The aims of this study were to evaluate the relationship between anticholinergic drug burden (ACB) cognitive impairment, physical frailty, and cognitive frailty, and to determine if ACB is predictive of these phenotypes when modeled with biological and genomic biomarkers. Methods In a retrospective cohort study, a total of 1,453 adults aged 20–102 years were used to examine ACB as a predictor for cognitive impairment, physical frailty, and cognitive frailty. Anticholinergic burden is examined as a predictor for all phenotypes in a cross-sectional analysis using logistic, ordinal regression models, and Extreme Gradient Boosting for population predictive modeling. Results A significant association was found between ACB and cognitive decline (p = .02), frailty (p &lt; .001), and cognitive frailty (p &lt; .001). The odds of cognitive impairment increased by 1.21 (95% confidence interval [CI] = 1.06–1.37, p &lt; .001), odds of being frail increased by 1.33 (95% CI = 1.18–1.50, p &lt; .001), and odds of having cognitive frailty increased by 1.36 (95% CI = 1.21–1.54, p &lt; .001). Population modeling results indicated ACB score as one of the stronger predictors for cognitive impairment, physical frailty, and cognitive frailty with area under the curves ranging from 0.81 to 0.88. Conclusions Anticholinergic medications are a potentially modifiable risk factor for the prevention of cognitive and physical decline. Identification of reversible causes for cognitive and physical impairment is critical for the aging population. These findings encourage new research that may lead to effective interventions for deprescribing programs for the prevention of cognitive and physical decline in older adults.

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