Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

Abstract

Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality, and their use should be limited in older people. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability.Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects.

High anticholinergic burden at admission associated with in‐hospital mortality in older patients: A comparison of 19 different anticholinergic burden scales

“…The number of people taking at least five drugs has increased from 12% to 49% within the recent 20 years 1 . Hence, it is not surprising that the prevalence of drug use with potent anticholinergic (ACH) activity has nearly doubled in the last two decades 2 . Drugs with ACH properties block acetylcholine by binding to its receptor in the peripheral and central nervous system.…”

“…1 Hence, it is not surprising that the prevalence of drug use with potent anticholinergic (ACH) activity has nearly doubled in the last two decades. 2 Drugs with ACH properties block acetylcholine by binding to its receptor in the peripheral and central nervous system. Though some medications are used intentionally for their ACH action, others have ACH activity unrelated to their mechanisms of action.…”

Letter to the Editor Regarding “Cognitive Decline Is Associated With an Accelerated Rate of Bone Loss and Increased Fracture Risk in Women: A Prospective Study from the Canadian Multicentre Osteoporosis Study”

“…(6) The prevalence of use of drugs with anticholinergic activity varies between 9.9% and 37% among community-dwelling adults aged over 65 years, and the total anticholinergic load is disproportionately higher especially in women and older participants. (7,8) Side effects include reduced balance, slower gait speed, decreased lower limb function, impaired attention and executive function, and blurred vision and increased risk of falls and fracture in this population, (6) all of which could be applicable to this study population.…”

A systematic review of interventions to reduce anticholinergic burden in older people with dementia in primary care

“…Despite well‐publicised risks, anticholinergic drug use among PwD remains widespread and has been increasing over recent decades 17–21 . Furthermore, studies have shown that PwD often experience a high anticholinergic burden (ACB), which refers to the cumulative effect of using multiple medications with anticholinergic properties concomitantly 17,22–24 .…”