scholarly journals Assessing Anticholinergic Effects in Older Adults

2020 ◽  
Author(s):  
Donna M. Lisi
Keyword(s):  
Older Adults ◽  
First Generation ◽  
Inappropriate Medication ◽  
Anticholinergic Drug ◽  
System Level ◽  
Blurred Vision ◽  
Anticholinergic Effects ◽  
Anticholinergic Medications ◽  
Inappropriate Medication Use ◽  
Drug Classes

Anticholinergic medications are widely used in older adults and are a common source of adverse events in this population. Common drug classes include antiarrhythmics, antidepressants, antiemetics, first generation antihistamines, urinary incontinence antimuscarinic agents, antiparkinsonian agents, antipsychotics, antispasmodics, and skeletal muscle relaxants. These drugs have been associated with delirium, cognitive impairment, sedation, dizziness, falls, fracture, constipation, urinary retention, blurred vision, tachycardia and dry mouth. If possible, these drugs should be avoided in older adults or less toxic agents within the class should be utilized. This chapter will explore the mechanism of action of anticholinergic drugs at both the cellular and organ system level; discuss how to assess for anticholinergic drug burden; list medications with anticholinergic effects as identified in the Beer’s criteria on potentially inappropriate medication use in older adults; review anticholinergic drug–drug interactions; describe contraindications to the use of anticholinergic agents; and explore practical considerations such as the availability of these substances in nonprescription medications, their use at end of life and deprescribing.

scholarly journals Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature

2017 ◽  
Vol 150 (3) ◽  
pp. 169-183 ◽  
Author(s):  
Tejal Patel ◽  
Karen Slonim ◽  
Linda Lee
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Adverse Events ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Adverse Outcomes ◽  
Potentially Inappropriate Medication ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Medication Use ◽  
Inappropriate Medications

Background: Older adults with dementia are at high risk for drug-related adverse outcomes. While much is known about potentially inappropriate medication use in older adults, its prevalence and characteristics among those with dementia are not as well elucidated. We conducted a literature review to examine the prevalence of potentially inappropriate medication use among home-dwelling older adults with dementia. Our secondary aim was to determine the most frequently implicated medications and factors associated with potentially inappropriate medication use. Methods: MEDLINE, EMBASE, CINAHL, and International Pharmaceutical Abstracts were searched between 1946 and 2014 for articles that referenced potentially inappropriate medication use and types of dementia. One reviewer screened all titles and abstracts from the initial search and full-text articles after the initial screen for eligibility, then 2 reviewers independently abstracted data from included studies. Results: Searches yielded 81 articles, of which 7 met inclusion criteria. Prevalence of potentially inappropriate medication use varied from 15% to 46.8%. No single drug or drug class was reported consistently across all studies as the most frequent potentially inappropriate medication, but anticholinergics and benzodiazepines, drugs that affect cognition, were among the most common medications or pharmacological classes listed. Discussion: Older adults with dementia may be particularly vulnerable to potentially inappropriate medications because of cognitive impairment from their condition and the greater likelihood of experiencing adverse events from medications. Given this population’s greater susceptibility to adverse events, more intense medication and patient monitoring may be warranted, especially among those taking anticholinergics and benzodiazepines, as these drugs can contribute to cognitive impairment.

scholarly journals Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

2021 ◽  
Vol 14 (9) ◽  
pp. 844
Author(s):  
Akshaya Srikanth Bhagavathula ◽  
Mohammed Assen Seid ◽  
Aynishet Adane ◽  
Eyob Alemayehu Gebreyohannes ◽  
Jovana Brkic ◽  
...  
Keyword(s):  
Older Adults ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Medication ◽  
Multivariable Logistic Regression Analysis ◽  
Routine Practice ◽  
Cross Sectional ◽  
Inappropriate Medication Use ◽  
High Prevalence ◽  
Sliding Scale

Few studies have been conducted on multimorbidity (two or more chronic diseases) and rational geriatric prescribing in Africa. This study examined the prevalence and determinants of multimorbidity, polypharmacy (five or more long-term medications), and potentially inappropriate medication (PIM) use according to the 2019 Beers criteria among the older adults attending chronic care clinics from a single institution in Ethiopia. A hospital-based cross-sectional study was conducted among 320 randomly selected older adults from 12 March 2020 to 30 August 2020. A multivariable logistic regression analysis was performed to identify the predictor variables. The prevalence of multimorbidity, polypharmacy, and PIM exposure was 59.1%, 24.1%, and 47.2%, respectively. Diuretics (10%), insulin sliding scale (8.8%), amitriptyline (7.8%), and aspirin (6.9%) were among the most frequently prescribed PIMs. Older patients experiencing pain flare-ups were more likely to have multimorbidity (adjusted odds ratio (AOR): 1.64, 95% confidence intervals: 1.13–2.39). Persistent anger (AOR: 3.33; 1.71–6.47) and use of mobility aids (AOR: 2.41, 1.35–4.28) were associated with polypharmacy. Moreover, cognitive impairment (AOR: 1.65, 1.15–2.34) and health deterioration (AOR: 1.61, 1.11–2.32) increased the likelihood of PIM exposure. High prevalence of multimorbidity and PIM use was observed in Ethiopia. Several important determinants that can be modified by applying PIM criteria in routine practice were also identified.

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.

Potentially Inappropriate Medication Use Among Institutionalized Older Adults at Nursing Homes in Puerto Rico

2018 ◽  
Vol 33 (11) ◽  
pp. 619-636 ◽  
Author(s):  
Bianca F. Nieves-Pérez ◽  
Sullynette Guerrero-De Hostos ◽  
Mariela I. Frontera-Hernández ◽  
Iadelisse Cruz González ◽  
José Josué Hernández-Muñoz
Keyword(s):  
Older Adults ◽  
Puerto Rico ◽  
Nursing Homes ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Potentially Inappropriate Medication ◽  
Inappropriate Medication Use
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