Use of Anticholinergics in the Nursing Home: An Empirical Study and Review

Abstract

The Medicare Utilization Review Committee conducted a survey to determine the use of drugs with anticholinergic effects in confused elderly nursing home patients. Twenty-nine patients (34.5 percent) were receiving anticholinergic drugs, predominantly from the antidepressant and antipsychotic class. Thioridazine (Mellaril) was the most frequently used antipsychotic. No patients received higher than the equivalent recommended daily dose of atropine when calculated in terms of relative anticholinergic potency. No statistically significant correlation could be found between the presence of confusion and the amount of anticholinergics administered. Confusion and cognitive deterioration frequently are encountered when caring for aged patients. Clinical experience and recent studies suggest that anticholinergics may increase the risk of or exacerbate existing confusion, and this possible effect of anticholinergic activity should be considered when prescribing for elderly patients.

The Use of Medicines with Anticholinergic Effects in Older People: A Population Study in an Urban Area of Sweden

“…The results from other studies vary, however. Seifert et al 7 reported that 34.5% of nursing home patients were receiving anticholinergic drugs, which is similar to our result. Other investigators have not presented the overall use of this group of medicines.…”

“…The use of neuroleptics, especially in institutions, was more common. Neuroleptic use in nursing homes was 33%, which is higher than the prevalences between 17 and 24% reported in previous studies 1,3,7 . In institutions in general, neuroleptic use was more than three times higher than that reported by Skoog et al in their study of 85‐year‐old subjects in Gothenburg 8 .…”

“…Even so, use of these drugs was low compared with other reports. For example, in the nursing home population studied here, 3.4% were taking antidepressant medicines compared with use of between 5 and 19% reported previously 1,3,7,30 . This low use may reflect an underdiagnosis of depression.…”

Memory Loss, Confusion, and Disorientation in an Elderly Woman Taking Meclizine

“…Over 600 plants, chemicals, and pharmaceutical products have anticholinergic properties 7 . Drugs with anticholinergic effects are frequently used in the elderly 8–10 . We have found that 45% of elderly patients in a chronic care institution were receiving at least one drug with anticholinergic side effects 11 .…”

The Relationship Between Anticholinergic Medications and Mini-Cog Scores in Older Adults Receiving Home Health Care

“…[1–4] Despite known potential adverse consequences, anticholinergic use is still common in older adults, both in long-term care and community settings. Older studies have reported anticholinergic medication use prevalence of 34% to 59% in skilled nursing facility residents [5, 6] and 23% to 50% in older adults in ambulatory care. [6–8]…”