Prevalence of Anticholinergic Medication Use in the Program of All-Inclusive Care for the Elderly

Covington, Les P; McCarrell, Jamie; Hoerster, Nicole S

doi:10.4140/tcp.n.2016.168

Cited by 7 publications

(5 citation statements)

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“…25,32 In populations with mixed cognitive abilities, women were more likely than men to have used a PIM 24,29 or a benzodiazepine, 33 but no association was observed between sex and antipsychotic use. 34 Three of the nine studies 20,25,27,29–34 investigating race found racial determinants of PIM use, but the directions differed by the studied population. 25,31,33 Marital status, 26,33 poverty, 26 education, 26,30,31,34 and length of stay 26,28,33 were not significant determinants of PIM use.…”

Section: Resultsmentioning

confidence: 97%

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Determinants of Potentially Inappropriate Medication Use in Long-Term and Acute Care Settings: A Systematic Review

Nothelle

Sharma

Oakes

et al. 2017

Journal of the American Medical Directors Association

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Background Potentially inappropriate medications (PIM) are widely used in institutionalized older adults, yet the key determinants that drive their use are incompletely characterized. Methods We systematically searched published literature within MEDLINE® and Embase® from January 1998 to March 2017. We searched for studies conducted in the United States that described determinants of PIM use in adults ≥60 years of age in a nursing home or residential care facility, in the Emergency Department (ED), or in the hospital. Paired reviewers independently screened abstracts and full text articles, assessed quality and extracted data. Results Among 30 included articles, 12 examined PIM use in the nursing home or residential care settings, 4 in the ED, 12 in acute-care hospitals, and 2 across settings. The Beers criteria were most frequently used to identify PIM use, which ranged from 3.6 to 92%. Across all settings, the most common determinants of PIM use were medication burden and geographic region. In the nursing home, the most common additional determinants were younger age, and diagnoses of depression or diabetes. In both the ED and hospital, patients receiving care in the West, Midwest, and South, relative to the Northeast, were at greater risk of receiving a PIM. Very few studies examined clinician determinants of PIM use; geriatricians used fewer PIMs in the hospital than other clinicians. Conclusions Among older adults, those who are on many medications are at increased risk for PIM use across multiple settings. We propose that careful testing of interventions that target modifiable determinants are indicated to assess their impact on PIM use.

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Section: Resultsmentioning

confidence: 97%

“…18,20,24–27,29–35 Five studies 25,26,31,33,34 evaluated the relationship between census region and PIM use, with three finding statistically significant differences across regions. 25,31,33 One study of Medicaid recipients in Kentucky found that those living in a nursing home were more likely to receive a PIM than those community-dwellers.…”

Section: Resultsmentioning

confidence: 99%

Determinants of Potentially Inappropriate Medication Use in Long-Term and Acute Care Settings: A Systematic Review

Nothelle

Sharma

Oakes

et al. 2017

Journal of the American Medical Directors Association

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“…Still, those services would not be using the same clinical decision support systems. It is possible that the effect of MRM could be attenuated when compared against programs with robust clinical pharmacy service offerings [ 46 , 48 , 49 , 50 ]. Finally, we were unable to demonstrate statistically significant differences between groups for their year-over-year change in the proportion of patients with ADEs.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Impact of Medication Risk Mitigation Services in Medically Complex Older Adults

Jin¹,

Yang²,

Bankes³

et al. 2022

Healthcare

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Adverse drug events (ADEs) represent an expensive societal burden that disproportionally affects older adults. Therefore, value-based organizations that provide care to older adults—such as the Program of All-Inclusive Care for the Elderly (PACE)—should be highly motivated to identify actual or potential ADEs to mitigate risks and avoid downstream costs. We sought to determine whether PACE participants receiving medication risk mitigation (MRM) services exhibit improvements in total healthcare costs and other outcomes compared to participants not receiving structured MRM. Data from 2545 PACE participants from 19 centers were obtained for the years 2018 and 2019. We compared the year-over-year changes in outcomes between patients not receiving (control) or receiving structured MRM services. Data were adjusted based on participant multimorbidity and geographic location. Our analyses demonstrate that costs in the MRM cohort exhibited a significantly smaller year-to-year increase compared to the control (MRM: USD 4386/participant/year [95% CI, USD 3040–5732] vs. no MRM: USD 9410/participant/year [95% CI, USD 7737–11,084]). Therefore, receipt of structured MRM services reduced total healthcare costs (p < 0.001) by USD 5024 per participant from 2018 to 2019. The large majority (75.8%) of the reduction involved facility-related expenditures (e.g., hospital admission, emergency department visits, skilled nursing). In sum, our findings suggest that structured MRM services can curb growing year-over-year healthcare costs for PACE participants.

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“…The results of this study reveal that SCD should not be considered to be clinically negligible, particularly in older adults under high ACB. In this regard, screening of anticholinergic drugs and calculation of ACB is of importance during routine geriatric assessment visits in older adults with SCD to reduce the development of cognitive impairment and dementia [37]. In addition, it would be helpful to raise awareness about the risk of cognitive impairment and other comorbid conditions due to high ACB among doctors and other health care providers.…”

Section: Discussionmentioning

confidence: 99%

Effect of anticholinergic burden on the development of dementia in older adults with subjective cognitive decline

Naharci

Cintosun

Öztürk

et al. 2017

Psychiatry and Clinical Psychopharmacology

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OBJECTIVE: Data on the effect of anticholinergic cognitive burden (ACB) in older adults with subjective cognitive decline (SCD) are limited. We aimed to study whether ACB increases the future risk of dementia in older adults with SCD. METHODS: The retrospective cohort analysis was carried out on 1496 older adults. Out of those, 109 older patients with SCD followed up over 36 months were studied. They were divided into two groups according to cognitive status at last visit: group I included the subjects with SCD who did not progress to dementia and group II included those who progressed to dementia. The drugs with anticholinergic effects that were received by subjects three months or more were identified from records. The drugs were categorized as having absent (ACB = 0), possible (ACB = 1), and definite (ACB = 2) anticholinergic properties based on an ACB scale. ACB was calculated for each subject by adding the score of each drug and classified as no or low ACB (ACB ≤ 2) and high ACB (ACB ≥ 3). RESULTS: The mean age of all subjects was 72.5 ± 6.3 years and 66.1% of the sample was female. The median follow-up time for all subjects was 75 months (range, 36-185). Fifteen (13.8%) of 109 participants with baseline SCD developed dementia. High ACB was present in 12 subjects (12.8%) in group I and 7 subjects (46.7%) in group II (p = .001). The 75-84 and 85 + age groups (hazard ratio (HR)

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Prevalence of Anticholinergic Medication Use in the Program of All-Inclusive Care for the Elderly

Cited by 7 publications

References 0 publications

Determinants of Potentially Inappropriate Medication Use in Long-Term and Acute Care Settings: A Systematic Review

Determinants of Potentially Inappropriate Medication Use in Long-Term and Acute Care Settings: A Systematic Review

Evaluating the Impact of Medication Risk Mitigation Services in Medically Complex Older Adults

Effect of anticholinergic burden on the development of dementia in older adults with subjective cognitive decline

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