Anti-Cholinergic Drug Burden Among Ambulatory Elderly Patients in a Nigerian Tertiary Healthcare Facility

Abstract

Background: The use of drugs with anticholinergic effects among elderly patients is associated with adverse clinical outcomes. There is paucity of information about anticholinergic drug burden among Nigerian elderly population.Objectives: To determine the anticholinergic drug burden among elderly Nigerian patients.Methods: This was a retrospective cross-sectional study conducted among elderly patients (aged 65 and above) who visited the Family Medicine outpatients’ clinics of the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria between July 1 and October 31, 2018. Information extracted from the case files included patient’s age, sex, diagnoses, and list of prescribed medications. Medicines with anticholinergic effects were identified and scored using the anticholinergic drug burden calculator (http://www.acbcalc.com).Results: The medical records of 400 patients were analyzed with females accounting for 60.5% of the study population. The mean age of participants was 73 ± 7.4 years with only 28 (7%) of patients having more than two co-morbid conditions. Polypharmacy was identified in 152 (38%) of the patients while 147 (36.7%) had drugs with anticholinergic effects prescribed. The anticholinergic burden was high in 60 (15%) patients. Polypharmacy was significantly associated with having more than two diagnosed conditions and high anticholinergic burden (p value of < 0 .001 and 0.013 respectively). There was significant correlation between total number of prescribed drugs and count of diagnoses (r = 0.598; p < 0 .000) and between total number of prescribed drugs and number of drugs with anticholinergic effects (r = 0 .196; p < 0 .000).Conclusion: The anticholinergic burden in this group of elderly Nigerian patients was low; majority (67%) had no exposure to drugs with anticholinergic effects with only 15% having high anticholinergic burden. Polypharmacy and multiple diagnosed conditions were positively associated with high anticholinergic burden. Based on the positive and significant correlations found in this study, a reduction in the number of prescribed medicines especially those with significant anticholinergic effects used for secondary indications may lessen the anticholinergic burden among the elderly.

Older adults’ exposure to anticholinergic medications: Implications for pharmaceutical care for Nigerian older adults

“…Reducing unnecessary anticholinergic medications in older adults can help to prevent or lessen cognitive decline, 37 falls, 38 and other functional impairments in this high-risk population. A previous study in southwest Nigeria found a higher exposure rate of 40.8% (60/147) to high-risk ACB medications, 19 compared with 26.6% (188/256) in our study. Furthermore, higher prevalence rates of 36.4% (20/55) and 48.4% (30/62) were reported in Malaysia and the United States, respectively.…”

“…Conversely, the prevalence rate noted in our study is remarkably greater than the rates (23.9%, 29.5%, and 35.7%) recorded in other studies conducted in southwest Nigeria. 19 , 28 , 36 Differences in physicians’ prescribing habits and disease burden may explain the observed discrepancies. Furthermore, varied prevalence rates of polypharmacy among older adults have been observed in different countries.…”

“… 14 , 15 , 17 , 18 To our knowledge, only one study has investigated Nigerian older adults’ exposure to anticholinergic medications. 19 This research was carried out in southwest Nigeria. Thus, the paucity of data from Africa, especially Nigeria, as well as the gap revealed in the previous Nigerian study 19 underscored the need for the present study.…”

“… 19 This research was carried out in southwest Nigeria. Thus, the paucity of data from Africa, especially Nigeria, as well as the gap revealed in the previous Nigerian study 19 underscored the need for the present study. Therefore, the objectives of the study were to investigate the prevalence of polypharmacy, describe the prescription patterns of anticholinergic medications, determine the prevalence of exposure to high-risk anticholinergic cognitive burden (ACB) medications, and identify the potential predictors of exposure to high-risk ACB medications in older adults in a Nigerian secondary hospital.…”

Polypharmacotherapy and cumulative anticholinergic burden in older adults hospitalised with fall

“…6,7 Polypharmacotherapy predisposes to higher anticholinergic burden (ACB), which is emerging as a risk factor for adverse events that disproportionately affect older adults, including falls, cognitive impairment and progression of neurodegenerative disease. [8][9][10][11][12] Many medications used to treat chronic conditions such as cardiovascular disease, hypertension, depression, urinary incontinence, pain, and allergies have weak anticholinergic properties, but the summative effects may have important implications and worse outcomes in older adults.…”