Anticholinergic burden: considerations for older adults

Abstract

Anticholinergic medications are frequently used in older adults to manage a wide range of chronic diseases. Anticholinergic burden associated with the use of multiple medications with anticholinergic effects is cumulative within an individual, and older adults are particularly susceptible to the adverse effects of these medications. These include dry mouth resulting in poor oral health, constipation, urinary retention and confusion. Use of anticholinergic medications has been associated with impaired cognitive and physical function, increased risk of falls, vascular events and hospitalisation. Consideration of anticholinergic burden is an important component of medication management for older adults. Several measures have been developed and validated to quantify anticholinergic burden, such as the Anticholinergic Drug Scale, Anticholinergic Risk Scale and the Anticholinergic Cognitive Burden scale. However, the evidence for translation of these measures into clinical practice is limited. This narrative review provides a brief clinical overview of the pharmacology of anticholinergic medications in the context of older adults, summarises approaches to measure anticholinergic burden, reviews recent evidence of the clinical impact of anticholinergic medications and discusses deprescribing strategies to manage anticholinergic burden for older adults in clinical practice.

Barriers and facilitators to reducing anticholinergic burden from the perspectives of patients, their carers, and healthcare professionals: A protocol for qualitative evidence synthesis

“…In some circumstances, these anticholinergic actions have intended therapeutic effects, for example, the use of amitriptyline in the treatment of chronic pain, but in others, they are a side effect of a drug used primarily for other pharmacological actions, such as atenolol . Anticholinergic drugs are prescribed for a wide range of conditions including gastrointestinal disorders, overactive bladder, allergies, depression, psychosis, and cardiovascular disease resulting in a high overall prevalence of these medications. Anticholinergic drugs have many adverse effects that include dry mouth, constipation, increased heart rate, confusion, and increased risk of falls .…”

“…Anticholinergic drugs are prescribed for a wide range of conditions including gastrointestinal disorders, overactive bladder, allergies, depression, psychosis, and cardiovascular disease resulting in a high overall prevalence of these medications. Anticholinergic drugs have many adverse effects that include dry mouth, constipation, increased heart rate, confusion, and increased risk of falls . Older people are more susceptible to these side effects .…”

“…Anticholinergic drugs have many adverse effects that include dry mouth, constipation, increased heart rate, confusion, and increased risk of falls . Older people are more susceptible to these side effects . The prescribing of multiple medicines for older adults in response to managing multiple morbidities in later life places them at greater risk of being exposed to anticholinergic drugs …”

“…Older people are more susceptible to these side effects . The prescribing of multiple medicines for older adults in response to managing multiple morbidities in later life places them at greater risk of being exposed to anticholinergic drugs …”

“…Population surveys suggest that up to 50% of community dwelling older adults may be taking one or more medications with anticholinergic effects . The potential impact of anticholinergics on an individual is termed as anticholinergic burden (ACB), and concomitant use of multiple medications with anticholinergic properties has a cumulative effect . Several scales to assess ACB have been developed, such as the Anticholinergic Drug Scale, Anticholinergic Cognitive Burden Scale and the Anticholinergic Risk Scale .…”