Potentially inappropriate anticholinergic medication use in older adults with dementia

Kachru, Nandita; Carnahan, Ryan M.; Johnson, Michael L.; Aparasu, Rajender R.

doi:10.1331/japha.2015.14288

Cited by 27 publications

(31 citation statements)

References 31 publications

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“…36 These findings could potentially be attributed to prescribe awareness concerning the prescription of PIMs in individuals of the older age group. 45 There was a high prevalence of PIMs (66.9%) in older adults diagnosed with dementia in our study, comparable to the prevalence (62%) in a study conducted in community-dwelling older adults in the United States. 46 48 There is a similar need to arrive at a global consensus through research on appropriate prescribing in older adults, presenting with different stages of dementia.…”

Section: Discussionsupporting

confidence: 81%

“…A higher proportion (72.3%) of relatively younger group (65‐75 y) of individuals with dementia were prescribed PIMs, which reflects the findings of the study performed by Hyttinen et al to evaluate PIMs prevalence in community‐dwelling older adults with and without Alzheimer's disease . These findings could potentially be attributed to prescribe awareness concerning the prescription of PIMs in individuals of the older age group …”

Section: Discussionsupporting

confidence: 71%

“…58 In our study, individuals who reported poor self-health had an increased likelihood of developing PIMs, identical to the results of a study conducted in the United States to assess potentially inappropriate anticholinergic medication use in home-dwelling older adults with dementia. 45 The Bronx Aging Study 59 revealed that patients with poor or fair ratings of self-perceived health utilized more prescription medications. Scores on self-perceived health status may be an appropriate measure of the syndrome.…”

Section: Discussionmentioning

confidence: 99%

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Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment

Bala

Jamieson

Nishtala

2018

Int J Geriat Psychiatry

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Objective To identify the prevalence and predictors of prescribing potentially inappropriate medications (PIMs) in a nationwide cohort of community dwellers with dementia requiring complex care needs. Methods A cross‐matched data of the International Resident Assessment Instrument‐Home Care (9.1) (interRAI‐HC) and prescribing data obtained from the Pharmaceutical Claims Data Mart (Pharms) extract files for older adults (≥65 y) requiring complex care needs were utilized for this study. The 2015 Beers criteria were applied to identify the prevalence of PIMs in older adults with dementia. Sociodemographic and clinical predictors of PIMs were analysed using a logistic regression model. Results The study population consisted of 16 568 individuals who had their first interRAI assessment from 1 January 2015 to 31 December 2015. The estimated prevalence of dementia was 13.2% (2190/16 568). 66.9% (1465/2190) of the older adults diagnosed with dementia were prescribed PIMs, of which anticholinergic medications constituted 59.6% (873/1465). Males and individuals who were prescribed a greater number of medications were more likely to be prescribed PIMs. Individuals over 85 years of age, Māori ethnic group of individuals, older adults who were being supervised with respect to their activities of daily living, and individuals who reported good or excellent self‐reported health had a lesser likelihood of being prescribed PIMs. Conclusion We found that PIMs are prescribed frequently in older adults with dementia. Comprehensive geriatric assessments can serve as a potential tool to decrease the occurrence of PIMs in vulnerable groups with poor functional and cognitive status.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment

Bala

Jamieson

Nishtala

2018

Int J Geriat Psychiatry

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“…Paroxetine is the SSRI with the most anticholinergic side effects which may lead to dry mouth, constipation, blurry vision, urinary retention as well as confusion in older individuals [32]. Additionally, paroxetine is a potent inhibitor of the cytochrome P450 2D6 hepatic pathway and therefore has considerable potential for drug interactions with patients taking other medications [33].…”

Section: Serotonin Specific Reuptake Inhibitors (Ssris)mentioning

confidence: 99%

Pharmacological Management of Anxiety Disorders in the Elderly

Crocco

Jaramillo

Cruz-Ortiz

et al. 2017

Curr Treat Options Psych

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Opinion Statement Anxiety disorders are common in the elderly. Additionally, anxiety symptoms often accompany co-morbid psychiatric, medical, as well as neurodegenerative diseases in the older population. Anxiety in the elderly, often accompanied by depression, can lead to worsening physical, cognitive and functional impairments in this vulnerable population. Antidepressants are considered first line treatment. Both SSRIs and SNRIs are efficacious and well-tolerated in the elderly. Some SSRIs are strong inhibitors of the cytochrome P450 hepatic pathway whereas others have less potential for drug interaction. Those antidepressants with more favorable pharmacokinetic profiles should be considered first-line in the treatment of anxiety. Mirtazapine and vortioxetine are also considered safe treatment options. Buspirone may have benefit, but lacks studies in elderly populations. Although tricyclic/tetracyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) may be effective in the elderly, their side effect and safety profiles are suboptimal and thus are not recommended in late-life. Benzodiazepines and beta blockers should generally be avoided when treating anxiety in the elderly. There is not enough evidence to support the use of antipsychotics or mood stabilizers given their risk of problems in both the long and short term. In addition, antipsychotics have a black box warning for increased mortality in elderly patients with dementia.

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“…On the basis of a strong recommendation grounded in systematic reviews of clinical studies, these 35 anticholinergic drugs are to be avoided regardless of indication . Previous studies investigated anticholinergic use at the national level but relied on self‐reported survey questionnaires from civilians and used old data and older versions of the Beers criteria . Furthermore, these studies were conducted cross‐sectionally such that they did not investigate secular trends of prescribing over time.…”

mentioning

confidence: 99%

National Prescribing Trends for High‐Risk Anticholinergic Medications in Older Adults

Rhee

Choi

Ouellet

et al. 2018

J American Geriatrics Society

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OBJECTIVES:To estimate prescribing tends of and correlates independently associated with high-risk anticholinergic prescriptions in adults aged 65 and older in officebased outpatient visits. DESIGN: Repeated cross-sectional analysis. SETTING: National Ambulatory Medical Care Survey (NAMCS). PARTICIPANTS: A national sample of office-based physician visits by adults aged 65 and older from 2006 to 2015 (n596,996 unweighted). MEASUREMENTS: Prescriptions of high-risk anticholinergics, regardless of indication, were identified, and overall prescribing trends were estimated from 2006 to 2015. Stratified analyses of prescribing trends according to physician specialty and anticholinergic drug class were also performed. We used a multivariable logistic regression analysis to estimate the odds of high-risk anticholinergic prescription. RESULTS: Between 2006 and 2015, a high-risk anticholinergic prescription was listed for 5,876 (6.2%) 96,996 visits of older adults, representative of 14.6 million total visits nationally. The most common drug classes were antidepressants, antimuscarinics, and antihistamines, which accounted for more than 70% of prescribed anticholinergics. Correlates independently associated with greater odds of receiving a high-risk anticholinergic prescription were female sex, the Southern geographic region, specific physician specialties (e.g., psychiatry, urology), receipt of 6 or more concomitantly prescribed medications, and related clinical diagnoses (e.g., urinary continence) (p<.01 for all). CONCLUSION: The prevalence of high-risk anticholinergic prescriptions was stable over time but varied according to physician specialty and drug class. Quality prescribing should be promoted because safer alternatives are available.

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Potentially inappropriate anticholinergic medication use in older adults with dementia

Cited by 27 publications

References 31 publications

Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment

Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment

Pharmacological Management of Anxiety Disorders in the Elderly

National Prescribing Trends for High‐Risk Anticholinergic Medications in Older Adults

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