Comparison of Nine Instruments to Calculate Anticholinergic Load in a Large Cohort of Older Outpatients: Association with Cognitive and Functional Decline, Falls, and Use of Laxatives

Mayer, Tanja; Meid, Andreas D.; Saum, Kai Uwe; Brenner, Hermann; Schöttker, Ben; Seidling, Hanna M.; Haefeli, Walter E.

doi:10.1016/j.jagp.2017.01.009

Cited by 34 publications

(51 citation statements)

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“…A comparison of scales in several studies showed that instruments differed in sensitivity and specificity because of their differences in identification criteria for anticholinergics. Despite this, most scores were associated with adverse clinical outcomes of interest ( 5 , 14 ). The strongest predictor was DBI – Anticholinergic Component (ACH) Score ( 14 ).…”

Section: Introductionmentioning

confidence: 94%

“…Commonly reported peripheral side effects of anticholinergic medicines include dry mouth, dry eyes, constipation, urinary retention, blurred vision and increased heart rate, while central effects range from dizziness, sedation, confusion and delirium ( 1 , 2 , 3 ). Multiple studies reported the association between anticholinergic effect on cognitive function ( 1 , 3 , 4 , 5 ), increased risk of delirium ( 3 ), dizziness and confusion ( 6 ), but also falls ( 1 , 3 , 6 ), hospitalisations ( 1 , 7 ), and physical function ( 1 , 5 , 8 ), especially in vulnerable populations such as old ( 1 ) or patients with Parkinson disease ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, there is a poor agreement between different anticholinergic scales in terms of medicines included and the results are, therefore, difficult to compare ( 13 , 14 ). Several studies, using different instruments, found the prevalence of exposure to anticholinergic medicines between 9% to 55.9% ( 5 , 14 , 15 ). A comparison of scales in several studies showed that instruments differed in sensitivity and specificity because of their differences in identification criteria for anticholinergics.…”

Section: Introductionmentioning

confidence: 99%

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

Gorup

Rifel

Šter

2018

Slovenian Journal of Public Health

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IntroductionAnticholinergic 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.

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Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Gorup

Rifel

Šter

2018

Slovenian Journal of Public Health

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“…The use of psychotropics is associated with falls among older people [2,3], especially among nursing-home residents [4]. Furthermore, drugs with anticholinergic properties (DAPs) are associated with an increased frequency of falls [5,6], while antihypertensives are associated with an increased risk for falls [2,3] and hip fractures [7].…”

Section: Introductionmentioning

confidence: 99%

Effect of Exercise on Drug-Related Falls Among Persons with Alzheimer's Disease: A Secondary Analysis of the FINALEX Study

et al. 2018

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Introduction No study has investigated how exercise modifies the effect of fall-related drugs (FRDs) on falls among people with Alzheimer's disease (AD). Objective The aim of this study was to investigate how exercise intervention and FRDs interact with fall risk among patients with AD. Methods In the FINALEX trial, community-dwelling persons with AD received either home-based or group-based exercise twice weekly for 1 year (n =129); the control group received normal care (n =65). The number of falls was based on spouses' fall diaries. We examined the incidence rate ratios (IRRs) for falls among both non-users and users of various FRDs (antihypertensives, psychotropics, drugs with anticholinergic properties [DAPs]) in both control and combined intervention groups. Results Between the intervention and control groups, there was no difference in the number of falls among those without antihypertensives or psychotropics. In the intervention group taking antihypertensives, the IRR was 0.5 falls/person-year (95% confidence interval [CI] 0.4-0.6), while in the control group, the IRR was 1.5 falls/person-year (95% CI 1.2-1.8) [p < 0.001 for group, p = 0.067 for medication, p < 0.001 for interaction]. Among patients using psychotropics, the intervention group had an IRR of 0.7 falls/person-year (95% CI 0.6-0.9), while the control group had an IRR of 2.0 falls/person-year (95% CI 1.6-2.5) [p < 0.001 for group, p = 0.071 for medication, p < 0.001 for interaction]. There was a significant difference in falls between the intervention and control groups not using DAPs (0.6, 95% CI 0.5-0.7; 1.2, 95% CI 1.0-1.4), and between the intervention and control groups using DAPs (1.1, 95% CI 0.8-1.3; 1.5, 95% CI 1.0-2.1) [p < 0.001 for group, p = 0.014 for medication, p = 0.97 for interaction]. Conclusion Exercise has the potential to decrease the risk for falls among people with AD using antihypertensives and psychotropics. Trial Registration ACTRN12608000037303.

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“…Another method to further refine the evaluation of ACB would be to consider the dosages of anticholinergic drugs via the Drug Burden Index [ 33 ]. A recently published cohort study of German older outpatients found a significant association of the drug Burden Index with Mini-Mental State Examination Score, Barthel index, Falls and use of laxatives [ 42 ]. We did not use this approach as it is more complicated and time-consuming to use in daily routine and it is not compatible with the scores used [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

An anticholinergic burden score for German prescribers: score development

2018

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BackgroundAnticholinergic drugs put elderly patients at a higher risk for falls, cognitive decline, and delirium as well as peripheral adverse reactions like dry mouth or constipation. Prescribers are often unaware of the drug-based anticholinergic burden (ACB) of their patients. This study aimed to develop an anticholinergic burden score for drugs licensed in Germany to be used by clinicians at prescribing level.MethodsA systematic literature search in pubmed assessed previously published ACB tools. Quantitative grading scores were extracted, reduced to drugs available in Germany, and reevaluated by expert discussion. Drugs were scored as having no, weak, moderate, or strong anticholinergic effects. Further drugs were identified in clinical routine and included as well.ResultsThe literature search identified 692 different drugs, with 548 drugs available in Germany. After exclusion of drugs due to no systemic effect or scoring of drug combinations (n = 67) and evaluation of 26 additional identified drugs in clinical routine, 504 drugs were scored. Of those, 356 drugs were categorised as having no, 104 drugs were scored as weak, 18 as moderate and 29 as having strong anticholinergic effects.ConclusionsThe newly created ACB score for drugs authorized in Germany can be used in daily clinical practice to reduce potentially inappropriate medications for elderly patients. Further clinical studies investigating its effect on reducing anticholinergic side effects are necessary for validation.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0929-6) contains supplementary material, which is available to authorized users.

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Comparison of Nine Instruments to Calculate Anticholinergic Load in a Large Cohort of Older Outpatients: Association with Cognitive and Functional Decline, Falls, and Use of Laxatives

Cited by 34 publications

References 29 publications

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

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

Effect of Exercise on Drug-Related Falls Among Persons with Alzheimer's Disease: A Secondary Analysis of the FINALEX Study

An anticholinergic burden score for German prescribers: score development

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