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

Abstract

Background: Anticholinergic 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. Methods: We 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. Results: Prevalence 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). Conclusions: Use 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.

Reducing risks associated with medicines and lifestyle in a residential care population with intellectual disabilities: evaluation of a pharmacy review initiative in England

“… 21–23 In this study, approximately three-quarters of the residents were prescribed at least one medicine with anticholinergic activity, of whom over a third had a high anticholinergic burden score. This is higher than or at the very highest end of recent estimates of 20%–50% of older people in England being prescribed at least one medication with anticholinergic activity, 20 24 even though the average age of the residents in this study was only 56. Our findings therefore strongly support the high prevalence of anticholinergic prescribing in the ID population highlighted in the 2018 LeDeR report and confirms the need for service development initiatives such as is reported here to support the work of the NHS England STOMP programme to reduce overmedication in the ID population.…”

“…There is increasing evidence of medicines with anticholinergic properties being associated with falls, cognitive deterioration, drowsiness, constipation in older people, an increased risk of dementia and higher mortality. 20 As such, the use of these medicines should be limited in older people. There is also evidence that these medicines are more commonly prescribed to patients with ID and that these patients are more likely to be prescribed anticholinergic medication to treat symptoms of antipsychotic agents.…”

Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications

“…Despite the anticholinergic risk and deprescribing interventions, the prevalence of anticholinergic use is on the rise. 30 Recently, little is known about barriers to reduce anticholinergic use in older adults. 31 Future research should identify such barriers to guide doctors and pharmacists to avoid prescribing anticholinergics to older patients.…”

Associations Between Anticholinergic Medication Exposure and Adverse Health Outcomes in Older People with Frailty: A Systematic Review and Meta-analysis

“…There is also robust evidence of cumulative adverse effects of multiple anticholinergic medicines [11][12][13][14], referred to as anticholinergic burden [15], found to be associated with adverse outcomes including physical impairment, falls, cognitive dysfunction and all-cause mortality [11][12][13][14]. Older people are more likely to be exposed to potent anticholinergic medicines, with the prevalence of such prescribing increasing in this population [16]. This is despite the availability of criterion-based resources, such as the Beers and STOPP/START criteria, which focus on the list of anticholinergic medicines that should be avoided, or used with caution in certain clinical scenarios [17,18].…”