Simultaneous usage of dementia medications and anticholinergics among <scp>A</scp>sians and <scp>P</scp>acific <scp>I</scp>slanders

Schultz, Bruce D.; Takeshita, Junji; Goebert, Deborah; Takeshita, Steven; Lu, Brett Y.; Guilloux, Alexandre; Higa, Joy

doi:10.1111/psyg.12267

Cited by 4 publications

(3 citation statements)

References 17 publications

(18 reference statements)

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“…Two studies reported on potentially inappropriate medication use—“drugs that should generally be avoided because they are ineffective or pose an unnecessarily high risk for older adults, and drugs that are appropriate to use in older persons only at certain doses, frequencies, or duration of therapies.” 58 One study reported higher rates of potentially inappropriate medication use in Hispanic Americans compared to NHW persons 58 and another found higher rates of concurrent use of medications with anti‐cholinergic properties and anti‐dementia medications in NHW and Native Hawaiians compared to Asian Americans 59 . Finally, several studies reported racial/ethnic differences in patterns of use of drugs for hypertension and other medical conditions in PLWD 46,60,61 .…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported on potentially inappropriate medication use—“drugs that should generally be avoided because they are ineffective or pose an unnecessarily high risk for older adults, and drugs that are appropriate to use in older persons only at certain doses, frequencies, or duration of therapies.” 58 One study reported higher rates of potentially inappropriate medication use in Hispanic Americans compared to NHW persons 58 and another found higher rates of concurrent use of medications with anti‐cholinergic properties and anti‐dementia medications in NHW and Native Hawaiians compared to Asian Americans. 59 Finally, several studies reported racial/ethnic differences in patterns of use of drugs for hypertension and other medical conditions in PLWD. 46 , 60 , 61 Among the studies of medication for other medical conditions, a Medicare Comprehensive Medication Review was found to reduce disparities in statin non‐adherence for Hispanic American PLWD.…”

Section: Resultsmentioning

confidence: 99%

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Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

Hinton,

Tran,

Peak

et al. 2024

Alzheimer's & Dementia

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INTRODUCTIONWe set out to map evidence of disparities in Alzheimer's disease and Alzheimer's disease related dementias healthcare, including issues of access, quality, and outcomes for racial/ethnic minoritized persons living with dementia (PLWD) and family caregivers.METHODSWe conducted a scoping review of the literature published from 2000 to 2022 in PubMed, PsycINFO, and CINAHL. The inclusion criteria were: (1) focused on PLWD and/or family caregivers, (2) examined disparities or differences in healthcare, (3) were conducted in the United States, (4) compared two or more racial/ethnic groups, and (5) reported quantitative or qualitative findings.RESULTSKey findings include accumulating evidence that minoritized populations are less likely to receive an accurate and timely diagnosis, be prescribed anti‐dementia medications, and use hospice care, and more likely to have a higher risk of hospitalization and receive more aggressive life‐sustaining treatment at the end‐of‐life.DISCUSSIONFuture studies need to examine underlying processes and develop interventions to reduce disparities while also being more broadly inclusive of diverse populations.

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Section: Resultsmentioning

confidence: 99%

“…Two studies reported on potentially inappropriate medication use—“drugs that should generally be avoided because they are ineffective or pose an unnecessarily high risk for older adults, and drugs that are appropriate to use in older persons only at certain doses, frequencies, or duration of therapies.” 58 One study reported higher rates of potentially inappropriate medication use in Hispanic Americans compared to NHW persons 58 and another found higher rates of concurrent use of medications with anti‐cholinergic properties and anti‐dementia medications in NHW and Native Hawaiians compared to Asian Americans. 59 Finally, several studies reported racial/ethnic differences in patterns of use of drugs for hypertension and other medical conditions in PLWD. 46 , 60 , 61 Among the studies of medication for other medical conditions, a Medicare Comprehensive Medication Review was found to reduce disparities in statin non‐adherence for Hispanic American PLWD.…”

Section: Resultsmentioning

confidence: 99%

Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

Hinton,

Tran,

Peak

et al. 2024

Alzheimer's & Dementia

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“…One study showed that 35.4% of patients received these two drug types in combination [ 25 ]. The use of these medications in combination is likely to decrease their pharmacological benefit as they counteract each other [ 26 ], making their simultaneous use seldomly appropriate due to the drugs’ invalidating pharmacological effect [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy in an Elderly Population: Enhancing Medication Management Through the Use of Clinical Decision Support Software Platforms

Keine¹,

Zelek²,

Walker³

et al. 2019

Neurol Ther

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Introduction Polypharmacy is a growing problem in the United States. The use of multiple medications increases the likelihood that a patient will experience potential drug interactions and adverse drug reactions (ADRs). Those individuals with dementia or Alzheimer’s disease (AD) are at greater risk, due to age, comorbidities, and an increased likelihood of being on a greater number of neuroactive medications. Methods uMETHOD Health (uMH) has developed a precision medicine platform to address dementia and mild AD through the creation of personalized, multidomain treatment plans. Many interactions and ADRs may be observed, such as drug–drug interactions (DDIs), drug–gene interactions (DGIs), anticholinergic cognitive burden (ACB), and depression-inducing drugs (DIDs). uMH’s algorithms can parse these interactions, rate them based on input from open-source databases, and then record all these interactions in a generated treatment plan. A total of 295 individuals aged 65 and older were included in this analysis. Results Of 295 individuals, 97.59% were on at least one medication, with an overall mean of 11.5 medications per person; 83.66% were on five or more medications. A total of 102 DGIs, 3642 DDIs, and one high-priority DDI were found in this population. There was a significant increase in the number of DDIs as medications per person increased ( P value < 0.0001). Of the population, 65.86% were on one or more anticholinergic drugs. There was a significant difference in the ACB score between individuals with cognitive decline and those without. In total, 60.98% of the overall population were on DIDs, with a mean of 1.19 medications per person. Conclusions The results of this work show that older populations have a high medication burden. With the growing elderly and AD populations, medication management for polypharmacy is a need that grows direr every year. uMH’s platform was able to identify a multitude of polypharmacy problems that individuals are currently facing. Funding uMETHOD Health.

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Anticholinergic burden of patients with dementia attending a Psychiatry of Later Life service

Vaughan

Flynn

Greene

2019

Ir. j. psychol. Med.

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Objectives. Older adults with dementia are particularly vulnerable to adverse outcomes resulting from anticholinergic use. We aimed to: (i) Examine the anticholinergic burden of patients with dementia attending a Psychiatry of Later Life (PLL) service (ii) Examine concomitant prescription of acetylcholinesterase inhibitors (AChEIs) and anticholinergics and (iii) Compare the Anticholinergic Cognitive Burden (ACB) scale with a recently published composite list of anticholinergics. Methods. Retrospective chart review of new referrals with a diagnosis of dementia (n = 66) seen by the PLL service, Tallaght University Hospital, Dublin, Ireland, over a consecutive period of 4 months. Results. The mean ACB score was 2.2 (range = 0–9, SD = 2.1). 37.9% (n = 25) had a clinically significant ACB score (>3) and 42.1% (n = 8) of those taking AChEIs had a clinically significant ACB score. A significantly greater number of medications with anticholinergic activity were identified using the composite list versus the traditional ACB scale (2.3 v.1.5, p = 0.001). Conclusions. We demonstrated a significant anticholinergic burden amongst patients with dementia attending a specialist PLL service. There was no difference in anticholinergic burden between groups prescribed and not prescribed AChEIs, indicating that these medications are being prescribed without discontinuation of potentially inappropriate medications with anticholinergic activity. The true anticholinergic burden experienced by patients may be underestimated by the use of the ACB score alone, although the clinical significance of this finding is unclear. Calculation of true clinical anticholinergic burden load and its translation to a specific rating scale remains a challenge.

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Simultaneous usage of dementia medications and anticholinergics among Asians and Pacific Islanders

Cited by 4 publications

References 17 publications

Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

Polypharmacy in an Elderly Population: Enhancing Medication Management Through the Use of Clinical Decision Support Software Platforms

Anticholinergic burden of patients with dementia attending a Psychiatry of Later Life service

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