Anticholinergic and sedative medication use in older community‐dwelling people: A national population study in the Netherlands

Meer, Helene G van der; Taxis, Katja; Teichert, Martina; Griens, Fabiënne; Pont, Lisa G.; Wouters, Hans

doi:10.1002/pds.4698

Cited by 10 publications

(11 citation statements)

References 25 publications

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“…Medications with anticholinergic activity (MACs) are used for the treatment of various conditions including Parkinson's disease, depression, cardiovascular diseases, asthma, chronic obstructive pulmonary disease (COPD), allergies as well as incontinence and overactive bladder [1,2]. Prevalence of use of MACs differs depending on the study population: in community dwelling or general populations aged 65 and older between 9 and 57%; [3][4][5] among nursing home residents between 55 and 77% [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Anticholinergic Burden and Fractures: A Systematic Review with Methodological Appraisal

et al. 2020

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Introduction Medications with anticholinergic activity (MACs) are used to treat diseases common in older adults. Evidence on the association between anticholinergic burden (AB) and increased risk of fractures and osteoporosis or reduced bone mineral density (BMD) is inconsistent. Our aim was to conduct a systematic review of observational studies on AB with fractures and osteoporosis or reduced BMD and provide methodological appraisal of included studies. Methods We searched MEDLINE, EMBASE, Science Citation Index and CENTRAL as well as grey literature from database inception up to August 2020. Eligibility criteria were: observational design, AB-exposure measured through a scale, fracture of any type or osteoporosis or reduced BMD as outcome, and reported measure of association between exposure and outcome. No restrictions related to time, language or type of data were applied. Eligibility and risk of bias assessment as well as data extraction were performed independently by two reviewers. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale and the RTI Item Bank. Results The majority of the nine included studies had low risk of bias but heterogeneous methodology. No study used a new user design. Seven studies reported an increased risk of fractures associated with AB. In four studies using the Anticholinergic Risk Scale (ARS), adjusted risk of fractures was increased by 2-61% for ARS = 1, by 0-97% for ARS = 2, by 19-84% for ARS = 3, and by 56-96% for ARS ≥ 4; in three studies the ARS was aggregated, risk increased by 39% for ARS = 1-2 and 17% for ARS = 2-3. Two studies reported increased risk of fractures of 14 and 52% in the highest AB-category and one study reported that change in ARS of ≥ 3 during hospitalization was associated with a 321% increased risk in fractures. Two studies did not find an association between AB and fractures. The association between AB and osteoporosis or reduced BMD could only be assessed in two studies, one reporting increased risk of lower BMD at Ward's triangle, the other reporting no association between AB and BMD T-score change at the femoral neck. Discussion Our study suggests an association between AB and increased risk of fractures with possible dose-exposure gradient in studies using the ARS. The low number of studies and heterogeneity of methods calls for the conduct of more studies. Plain language summary We conducted a study investigating the risk of fractures associated with anticholinergic burden, which is the result of taking one or more medication with anticholinergic activity. The results of our study suggest that persons who experience anticholinergic burden might have a higher risk of fractures. However, since we were only able to include nine studies, more studies conducted in a similar way are needed. Oliver Riedel and Federica Pisa share senior authorship. At the time of study conception and coordination, FEP worked at the Leibniz Institute for Prevention Research and Epidemiology-BIPS. From 1st March 2020 she is working at Bayer AG....

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Section: Introductionmentioning

confidence: 99%

Anticholinergic Burden and Fractures: A Systematic Review with Methodological Appraisal

et al. 2020

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“…46,47 Four prior pharmacy claims-based DBI implementations have been reported. 29,30,33,34 Two described short-term exposure (1-month or 4-month) and two described annual exposure. Of the short-term exposure studies, the Finnish study had a matched design in which patients with an Alzheimer's disease diagnosis were matched to those without, rather than a general population, making its results difficult to compare.…”

Section: Discussionmentioning

confidence: 99%

“…32 Recently, the DBI was adapted for implementation using healthcare databases in New Zealand, Finland, Ireland, and the Netherlands. 29,30,33,34 Our study sought to expand DBI accessibility for future claims-based research quantifying anticholinergic and sedating drug dispensing in the US. We developed an updated US-based DBI drug list and operationalized the DBI for Medicare claims, and used this framework to (a) measure the monthly distribution based on mean daily DBI, (b) identify patient-level predictors of high mean daily DBI exposure, and (c) describe temporal trends in the prevalence of several DBI thresholds and the proportion of commonly dispensed medications.…”

Section: Introductionmentioning

confidence: 99%

Quantifying cumulative anticholinergic and sedative drug load among US Medicare Beneficiaries

Shmuel

Pate

Pepin

et al. 2020

Pharmacoepidemiology and Drug

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PurposeMedications with anticholinergic and sedative properties are widely used among older adults despite strong evidence of harm. The drug burden index (DBI), a pharmacological screening tool, measures these properties across drug classes, and higher DBI drug exposure (DBI > 1) has been associated with certain physical function‐related adverse events. Our aim was to quantify mean daily DBI drug exposure among older adults in the United States (US).MethodsWe screened medications for DBI properties and operationalized the DBI for US Medicare claims. We then conducted a retrospective cohort study of a 20% random, nationwide sample of 4 137 384 fee‐for‐service Medicare beneficiaries aged 66+ years (134 757 039 person‐months) from January 2013 to December 2016. We measured the monthly distribution based on mean daily DBI, categorized as (a) >0 vs 0 (any use) and (b) 0, 0 < DBI ≤ 1, 1 < DBI ≤ 2, and DBI > 2, and examined temporal trends. We described patient‐level factors (eg, demographics, healthcare use) associated with high (>2) vs low (0 < DBI≤1) DBI drug exposure.ResultsThe distribution of the mean daily DBI, aggregated at the month‐level, was: 58.1% DBI = 0, 29.0% 0 < DBI≤1, 9.3% 1 < DBI≤2, and 3.7% DBI > 2. Predictors of high monthly DBI drug exposure (DBI > 2) included certain indicators of increased healthcare use (eg, high number of drug claims), white race, younger age, frailty, and a psychosis diagnosis code.ConclusionsThe predictors of high DBI drug exposure can inform discussions between patients and providers about medication appropriateness and potential de‐prescribing. Future Medicare‐based studies should assess the association between the DBI and adverse events.

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“…was based on previous studies, where this highest threshold category was considered as a high anticholinergic/sedative load. 24,27,28 For method 2, all potential FRIDs (available in Table 1 of appendix A) dispensed by the pharmacy in the period (t = −270 to −180 days)…”

Section: Outcome Definitionsmentioning

confidence: 99%

Using pharmacy dispensing data to predict falls in older individuals

Gemmeke

Koster

Pajouheshnia

et al. 2020

Brit J Clinical Pharma

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Aims: Associations between individual medication use and falling in older individuals are well-documented. However, a comprehensive risk score that takes into account overall medication use and that can be used in daily pharmacy practice is lacking. We, therefore, aimed to determine whether pharmacy dispensing records can be used to predict falls. Methods: A retrospective cohort study was conducted using pharmacy dispensing data and self-reported falls among 3454 Dutch individuals aged ≥65 years. Two different methods were used to classify medication exposure for each person: the drug burden index (DBI) for cumulative anticholinergic and sedative medication exposure as well as exposure to fall risk-increasing drugs (FRIDs). Multinomial regression analyses, adjusted for age and sex, were conducted to investigate the association between medication exposure and falling classified as nonfalling, single falling and recurrent falling. The predictive performances of the DBI and FRIDs exposure were estimated by the polytomous discrimination index (PDI). Results: There were 521 single fallers (15%) and 485 recurrent fallers (14%). We found significant associations between a DBI ≥1 and single falling (adjusted odds ratio: 1.30 [95% confidence interval {CI}: 1.02-1.66]) and recurrent falling (adjusted odds ratio: 1.60 [95%CI: 1.25-2.04]). The PDI of the DBI model was 0.41 (95%CI: 0.39-0.42) and the PDI of the FRIDs model was 0.45 (95%CI: 0.43-0.47), indicating poor discrimination between fallers and nonfallers. Conclusion: The study shows significant associations between medication use and falling. However, the medication-based models were insufficient and other factors should be included to develop a risk score for pharmacy practice. K E Y W O R D S dispensing records, drug burden index, elderly, fall risk-increasing drugs, falling, risk prediction The authors confirm that the Principal Investigator for this paper is Marcel Bouvy and that he had direct clinical responsibility for participants.

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Anticholinergic and sedative medication use in older community‐dwelling people: A national population study in the Netherlands

Cited by 10 publications

References 25 publications

Anticholinergic Burden and Fractures: A Systematic Review with Methodological Appraisal

Anticholinergic Burden and Fractures: A Systematic Review with Methodological Appraisal

Quantifying cumulative anticholinergic and sedative drug load among US Medicare Beneficiaries

Using pharmacy dispensing data to predict falls in older individuals

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