Prevalence and Predictors of Anticholinergic Medication Use in Elderly Nursing Home Residents with Dementia

Abstract

Over one in five elderly nursing home residents with dementia used medications with marked anticholinergic activities. The study findings suggest the need to optimize the use of anticholinergic medications in vulnerable patients with dementia given the potentially severe adverse cognitive effects of these agents.

Potentially Inappropriate Anticholinergic Medication Use in Community-Dwelling Older Adults: A National Cross-Sectional Study

“…Some studies that have examined anticholinergic use found prevalence rates of 10.5-81.6 % [24][25][26][27][28] in older adults and 10.07-67.96 % [29][30][31] in older adults with dementia. The study design and methodological differences, along with the study settings, may account for these variations.…”

Use of Drugs with Anticholinergic Properties Among Nursing Home Residents with Dementia: A National Analysis of Medicare Beneficiaries from 2007 to 2008

“…[4-7] These effects include falls, confusion, cognitive impairment, sedation, delirium, and increased risk of frailty. [6,8,9] Because age and ADRD are both associated with central cholinergic deficiency, DAP use may exacerbate dementia-related symptoms. [6]…”

“…[6,8,9] Because age and ADRD are both associated with central cholinergic deficiency, DAP use may exacerbate dementia-related symptoms. [6]…”

Effect of anticholinergic drugs on cognitive impairment in the elderly

“…26 The clinical reality does not adapt to the evidence and even, in higher-risk conditions, to experience side effects, consumption shoots up, as occurs in nursing home residents, 27,29 inpatients 20 or in patients with dementia. 28 This involves an increase in side effects, but, at least in Spain, this kind of iatrogenia does not seem to awaken the consistent interest, in spite of the wrong diagnoses and treatments it implies. Even when an AChEI is used, anticholinergic drugs (with potential antagonistic effect) are frequently dispensed, 11,47 although there is no evidence-based justification for the combined use 10,48 and the optimisation of treatment in dementia has been proven to be efficient.…”

“…In a study in nursing homes, Chatterjee et al 28 found that 68% of the residents took level 1 drugs (potential anticholinergic action) according to the ADS and 21% took level 2 or 3 drugs (potent anticholinergic action). Conspicuous findings of the study included the fact that, as age increased, fewer drugs with anticholinergic effect were used, and that having a mental illness (anxiety, depression and schizophrenia) or movement disorders increased the risk of receiving high-potency anticholinergic drugs.…”