Polypharmacy and cumulative anticholinergic burden in older adults hospitalized with fall

Abstract

Introduction:Polypharmacy is a growing phenomenon associated with adverse effects in older adults. We assessed the potential confounding effects of cumulative anticholinergic burden (ACB) in patients who were hospitalized with falls. Methods:A noninterventional, prospective cohort study of unselected, acute admissions aged ≥ 65 years. Data were derived from electronic patient health records.Results were analyzed to determine the frequency of polypharmacy and degree of ACB and their relationship to falls risk. Primary outcomes were polypharmacy, defined as prescription of 5 or more regular oral medications, and ACB score.Key Results: Four hundred eleven (411) consecutive subjects were included, mean age 83.8 ± 8.0 years: 40.6% men. There were 38.4% patients who were admitted with falls.

Examining potentially inappropriate medication use among elderly individuals in palliative care: A comprehensive study

“…In a study by Montero Odasso et al it was reported risk for falls was increased by 12–16 % while the risk for incident falls was increased by 5–7% with each additional drug [ 33 ]. The correlation between falls and polypharmacy, in addition to being associated with multiple medication use, also appears to be attributable to PIMs, particularly in individuals taking anticholinergic medications [ 34 ].…”

“…In a study on patients receiving palliative care, McNeill et al found PIM prevalence as 19 % [ 37 ]. In a Turkish study on patients receiving home care services, it was found that PIM prevalence was 53 % according to Beers criteria and 40 % according to the TIME-to-STOP criteria [ 34 ]. In a study about elderly patients receiving palliative care, Sevilla-Sanchez et al investigated PIM using STOPP-Frail criteria and found that there was at least one PIM in 67.2 % of the patients and that “inappropriate use of gastrointestinal system and metabolism medicines without clinic indication” was the most common PIM [ 29 ].…”

Increased anticholinergic medication use in middle‐aged and older autistic adults and its associations with self‐reported memory difficulties and cognitive decline

“…Cognitive effects represent one type of adverse effect associated with AC medication exposure. There are other adverse effects of AC medications in aging persons, however, including elevated risk for falls (Stewart et al, 2021;Wong et al, 2023) and mortality (Ali et al, 2020;Graves-Morris et al, 2020;Ruxton et al, 2015). Thus, in addition to probing the cognitive-related effects of AC medication use, future work should also investigate other health-related adverse effects associated with AC medications in autistic persons.…”

Anticholinergic action is rarely a good thing

“…It is associated with numerous adverse effects, hospitalization, falls and mortality. 45,46 Polypharmacy predisposes to higher anticholinergic burden which may explain a proportion of the poor outcomes associated with it. 45…”

“…45,46 Polypharmacy predisposes to higher anticholinergic burden which may explain a proportion of the poor outcomes associated with it. 45…”