Anticholinergic medicines in an older primary care population: a cross-sectional analysis of medicines’ levels of anticholinergic activity and clinical indications

Abstract

Anticholinergic medicines are frequently prescribed in Australian general practice, and the majority of the 'community' anticholinergic burden is contributed by 'low'-anticholinergic potency medicines whose anticholinergic effects may be largely 'invisible' to prescribing GPs. Furthermore, the clinical 'phenotype' of the patient with high anticholinergic burden may be very different to common stereotypes (patients with urological, psychological or neurological problems), potentially making recognition of risk of anticholinergic adverse effects additionally problematic for GPs.

Prevalence, risk factors and adverse outcomes of anticholinergic burden in patients with advanced chronic conditions at hospital admission

“…The results confirm the hypothesis that there is a high presence of anticholinergic medication in this population (up to 82.1–93.6%). These results show an increased use of these drugs compared with population data, which showed their prevalence at approximately 10–45% . However, there are some higher‐risk populations that have shown a high use of anticholinergic drugs.…”

“…Thus, our population has a high prevalence of insomnia, often treated with benzodiazepines, and advanced cardiovascular disease with extensive use of diuretics, all resulting in a high use of anticholinergic medication. However, if we consider only those patients with a high anticholinergic burden, which in our population would range between 18.3% (according to the DBI scale) and 53.2% (according to the ADS scale), the prevalence in the use of anticholinergic drugs would be more similar to the data reported by epidemiological studies …”

“…The prevalence of the use of anticholinergic drugs varies according to the study setting. For outpatients aged >65 years, usage rates of 10% have been described . However, for patients diagnosed as suffering from dementia, these rates increased to 23.3%, 43% in the case of the USA National Ambulatory Medical Care Survey, or even 77% in the case of Medicare residence patients …”

Anticholinergic Exposure in a Cohort of Adults Aged 80 years and Over

“…Medications with anticholinergic properties are not always known to prescribers , nor are anticholinergic side effects recognized. The array of tools and methods available, each using different medications, can lead to confusion in knowing the true anticholinergic properties of medications.…”

Correction

“…Anticholinergic medicines in an older primary care population: a cross‐sectional analysis of medicines’ levels of anticholinergic activity and clinical indications. J Clin Pharm Ther , 2016; doi: …”