Impact of Multiple Low-Level Anticholinergic Medications on Anticholinergic Load of Community-Dwelling Elderly With and Without Dementia

Mate, Karen E, Kerr, Karen P, Pond, Dimity, Williams, Evan J, Marley, John, Disler, Peter, Brodaty, Henry and Magin, Parker J (2015) Impact of Multiple Low-Level Anticholinergic Medications on Anticholinergic Load of Community-Dwelling Elderly With and Without Dementia. Drugs and Aging, 32 2: 159-167. doi:10.1007/s40266-014-0230-0


Author Mate, Karen E
Kerr, Karen P
Pond, Dimity
Williams, Evan J
Marley, John
Disler, Peter
Brodaty, Henry
Magin, Parker J
Title Impact of Multiple Low-Level Anticholinergic Medications on Anticholinergic Load of Community-Dwelling Elderly With and Without Dementia
Journal name Drugs and Aging   Check publisher's open access policy
ISSN 1179-1969
1170-229X
Publication date 2015-02
Year available 2015
Sub-type Article (original research)
DOI 10.1007/s40266-014-0230-0
Open Access Status
Volume 32
Issue 2
Start page 159
End page 167
Total pages 9
Place of publication Auckland, New Zealand
Publisher Springer International Publishing
Collection year 2016
Language eng
Formatted abstract
Background
Elderly people, particularly those with dementia, are sensitive to adverse anticholinergic drug effects. This study examines the prevalence of anticholinergic medication, and anticholinergic load and its predictors, in community-dwelling elderly patients (aged 75 years and older) in Australia.

Methods
A research nurse visited the home of each participant (n = 1,044), compiled a list of current medications, and assessed participants’ cognitive status using a subsection of the revised Cambridge Examination for Mental Disorders of the Elderly (CAMCOG-R). Anticholinergic load was determined for each patient using the Anticholinergic Drug Scale (ADS).

Results
Multivariate analysis identified several patient factors that were associated with higher anticholinergic burden, including polypharmacy (i.e. taking five or more medications) (p < 0.001), increasing age (p = 0.018), CAMCOG-R dementia (p = 0.003), depression (p = 0.003), and lower physical quality of life (p < 0.001). The dementia group (n = 86) took a significantly higher number of medications (4.6 vs. 3.9; p = 0.04), and had a significantly higher anticholinergic load (1.5 vs. 0.8; p = 0.002) than those without dementia (n = 958). Approximately 60 % of the dementia group and 40 % of the non-dementia group were receiving at least one anticholinergic drug. This difference was due to the higher proportion of dementia patients taking level 1 (potentially anticholinergic) (p = 0.002) and level 3 (markedly anticholinergic) (p = 0.005) drugs.

Conclusions
There is considerable scope for the improvement of prescribing practices in the elderly, and particularly those with dementia. Importantly, level 1 anticholinergics have been identified as major contributors to the anticholinergic load in people with dementia. Longitudinal studies are required to determine the effects of increased and decreased anticholinergic load on cognitive function and other clinical outcomes for people with dementia.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Faculty of Medicine
Official 2016 Collection
 
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Citation counts: TR Web of Science Citation Count  Cited 3 times in Thomson Reuters Web of Science Article | Citations
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