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International Journal of Clinical Pharmacy

, Volume 40, Issue 1, pp 94–100 | Cite as

Inappropriate anticholinergic drugs prescriptions in older patients: analysing a hospital database

  • Laurie Ferret
  • Gregoire Ficheur
  • Emeline Delaviez
  • Michel Luyckx
  • Sophie Quenton
  • Regis Beuscart
  • Emmanuel Chazard
  • Jean-Baptiste BeuscartEmail author
Research Article

Abstract

Background Although many anticholinergics are inappropriate in older patients, the prescription of these drugs in a hospital setting has not been extensively studied. Objective To describe prescriptions of anticholinergic drugs in terms of frequency, at risk situations and constipation in hospitalized, older adults. Setting Using a database from a French general hospital (period 2009–2013), we extracted information on 14,090 hospital stays by patients aged 75 and over. Methods Anticholinergic drug prescriptions were automatically detected, with a focus on prescriptions in three well-known at-risk situations: falls, dementia, and benign prostatic hyperplasia. Cases of constipation that might have been causally related to the administration of anticholinergic drugs were screened for and reviewed. Main outcome measure Prescriptions with a high associated risk of anticholinergic related adverse reactions. Results Administration of an anticholinergic drug was detected in 1412 (10.0%) of the hospital stays by older patients. At-risk situations were identified in 413 (36.5%) of these stays: 137 (9.7%) for falls, 243 (17.2%) for dementia, and 114 (8.1%) for benign prostatic hyperplasia; 78 (18.9%) of these 413 stays featured a combination of two or three at-risk situations. Cases of constipation induced by anticholinergic drug administration were identified in 188 (13.3%) patient stays by using validated adjudication rules for adverse drug reactions: 85 and 103 cases were respectively evaluated as “possible” or “probable” adverse drug reactions. Conclusions Anticholinergic drugs prescription was found in 10.0% of hospitalized, older patients. More than one third of these prescriptions occurred in at-risk situations and more than one in ten prescriptions induced constipation.

Keywords

Anticholinergic drugs Elderly France Inappropriate prescribing Hospital pharmacy 

Notes

Acknowledgements

We sincerely thank all the physicians who participated in the PSIP project in their respective departments, notably Dr. Pascale Leurs, Dr. Olivier Brimont, Dr. Zine Baarir, and Dr. Philippe Lecocq. We thank Professor Eric Boulanger for critically revising the manuscript. We thank Renaud Perichon and Julien Soula (health informatics engineers) for their valuable assistance.

Funding

This study was funded by the Fondation pour la Recherche Médicale (FRM). The FRM did not influence study design, data collection, analysis and interpretation or presentation of the results.

Conflicts of interest

None of the authors have conflicts of interest to declare.

Supplementary material

11096_2017_554_MOESM1_ESM.pdf (183 kb)
Supplementary material 1 (PDF 182 kb)
11096_2017_554_MOESM2_ESM.pdf (189 kb)
Supplementary material 2 (PDF 189 kb)

References

  1. 1.
    By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46.Google Scholar
  2. 2.
    Laroche M-L, Charmes J-P, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol. 2007;63:725–31.CrossRefPubMedGoogle Scholar
  3. 3.
    O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44:213–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006;46:1481–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Gnjidic D, Cumming RG, Le Couteur DG, Handelsman DJ, Naganathan V, Abernethy DR, et al. Drug Burden Index and physical function in older Australian men. Br J Clin Pharmacol. 2009;68:97–105.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Cardwell K, Hughes CM, Ryan C. The association between anticholinergic medication burden and health related outcomes in the “oldest old”: a systematic review of the literature. Drugs Aging. 2015;32:835–48.CrossRefPubMedGoogle Scholar
  7. 7.
    Campbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, et al. The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging. 2009;4:225–33.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med. 2000;93:457–62.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kerdraon J, Eleouet M, Coignard P, Siproudhis L. Constipation iatrogène. Pelvi-Périnéologie. 2010;5:261–6.CrossRefGoogle Scholar
  10. 10.
    Flacker JM, Cummings V, Mach JR, Bettin K, Kiely DK, Wei J. The association of serum anticholinergic activity with delirium in elderly medical patients. Am J Geriatr Psychiatry. 1998;6:31–41.CrossRefPubMedGoogle Scholar
  11. 11.
    Landi F, Russo A, Liperoti R, Cesari M, Barillaro C, Pahor M, et al. Anticholinergic drugs and physical function among frail elderly population. Clin Pharmacol Ther. 2006;81:235–41.CrossRefPubMedGoogle Scholar
  12. 12.
    Verhamme KMC, Sturkenboom MCJM, Stricker BHC, Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug Saf. 2008;31:373–88.CrossRefPubMedGoogle Scholar
  13. 13.
    Kalisch Ellett LM, Pratt NL, Ramsay EN, Barratt JD, Roughead EE. Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia. J Am Geriatr Soc. 2014;62:1916–22.CrossRefPubMedGoogle Scholar
  14. 14.
    Carrière I, Fourrier-Reglat A, Dartigues J-F, Rouaud O, Pasquier F, Ritchie K, et al. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study. Arch Intern Med. 2009;169:1317–24.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kachru N, Carnahan RM, Johnson ML, Aparasu RR. Potentially inappropriate anticholinergic medication use in community-dwelling older adults: a national cross-sectional study. Drugs Aging. 2015;32:379–89.CrossRefPubMedGoogle Scholar
  16. 16.
    Kolanowski A, Fick DM, Campbell J, Litaker M, Boustani M. A preliminary study of anticholinergic burden and relationship to a quality of life indicator, engagement in activities, in nursing home residents with dementia. J Am Med Dir Assoc. 2009;10:252–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kumpula E-K, Bell JS, Soini H, Pitkälä KH. Anticholinergic drug use and mortality among residents of long-term care facilities: a prospective cohort study. J Clin Pharmacol. 2011;51:256–63.CrossRefPubMedGoogle Scholar
  18. 18.
    Beuscart J-B, Dupont C, Defebvre M-M, Puisieux F. Potentially inappropriate medications (PIMs) and anticholinergic levels in the elderly: a population based study in a French region. Arch Gerontol Geriatr. 2014;59:630–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Prosser H, Almond S, Walley T. Influences on GPs’ decision to prescribe new drugs-the importance of who says what. Fam Pract. 2003;20:61–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Lublóy Á. Factors affecting the uptake of new medicines: a systematic literature review. BMC Health Serv Res. 2014;14:469.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    WHO|International Classification of Diseases. WHO. [cited 2017 Feb 24]. http://www.who.int/classifications/icd/en/.
  22. 22.
    WHO|The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (ATC/DDD). WHO. [cited 2017 Feb 24]. http://www.who.int/classifications/atcddd/en/.
  23. 23.
    International Union of Pure and Applied Chemistry. IUPAC International Union of Pure and Applied Chemistry [cited 2017 Feb 24]. https://iupac.org/.
  24. 24.
    Chazard E, Mouret C, Ficheur G, Schaffar A, Beuscart J-B, Beuscart R. Proposal and evaluation of FASDIM, a fast and simple de-identification method for unstructured free-text clinical records. Int J Med Inf. 2014;83:303–12.CrossRefGoogle Scholar
  25. 25.
    Frenkel WJ, Jongerius EJ, Mandjes-van Uitert MJ, van Munster BC, de Rooij SE. Validation of the Charlson Comorbidity Index in acutely hospitalized elderly adults: a prospective cohort study. J Am Geriatr Soc. 2014;62:342–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Buntinx F, Niclaes L, Suetens C, Jans B, Mertens R, Van den Akker M. Evaluation of Charlson’s comorbidity index in elderly living in nursing homes. J Clin Epidemiol. 2002;55:1144–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J-C, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Chazard E, Băceanu A, Ferret L, Ficheur G. The ADE scorecards: a tool for adverse drug event detection in electronic health records. Stud Health Technol Inform. 2011;166:169–79.PubMedGoogle Scholar
  29. 29.
    Beuscart R, McNair P, Brender J. PSIP consortium. Patient safety through intelligent procedures in medication: the PSIP project. Stud Health Technol Inform. 2009;148:6–13.PubMedGoogle Scholar
  30. 30.
    Kramer MS, Leventhal JM, Hutchinson TA, Feinstein AR. An algorithm for the operational assessment of adverse drug reactions. I. Background, description, and instructions for use. JAMA. 1979;242:623–32.CrossRefPubMedGoogle Scholar
  31. 31.
    Wawruch M, Macugova A, Kostkova L, Luha J, Dukat A, Murin J, et al. The use of medications with anticholinergic properties and risk factors for their use in hospitalised elderly patients. Pharmacoepidemiol Drug Saf. 2012;21:170–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Egger SS, Bachmann A, Hubmann N, Schlienger RG, Krähenbühl S. Prevalence of potentially inappropriate medication use in elderly patients. Drugs Aging. 2006;23:823–37.CrossRefPubMedGoogle Scholar
  33. 33.
    Brayfield A, editor. Martindale: the complete drug reference. 38th ed. London: The Pharmaceutical Press; 2014.Google Scholar
  34. 34.
    Inouye SK. Predisposing and precipitating factors for delirium in hospitalized older patients. Dement Geriatr Cogn Disord. 1999;10:393–400.CrossRefPubMedGoogle Scholar
  35. 35.
    Ancelin ML, Artero S, Portet F, Dupuy A-M, Touchon J, Ritchie K. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ. 2006;332:455–9.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Gnjidic D, Le Couteur DG, Abernethy DR, Hilmer SN. A pilot randomized clinical trial utilizing the Drug Burden Index to reduce exposure to anticholinergic and sedative medications in older people. Ann Pharmacother. 2010;44:1725–32.CrossRefPubMedGoogle Scholar
  37. 37.
    Dennison C, Prasad M, Lloyd A, Bhattacharyya SK, Dhawan R, Coyne DK. The health-related quality of life and economic burden of constipation. PharmacoEconomics. 2012;23:461–76.CrossRefGoogle Scholar
  38. 38.
    Gnjidic D, Couteur DGL, Abernethy DR, Hilmer SN. Drug Burden Index and Beers Criteria: impact on functional outcomes in older people living in self-care retirement villages. J Clin Pharmacol. 2012;52:258–65.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  1. 1.EA 2694 - Santé publique: épidémiologie et qualité des soinsUniv. LilleLileFrance
  2. 2.Department of Medical Information and ArchivesCHU LilleLilleFrance
  3. 3.Department of PharmacyDenain General HospitalDenainFrance
  4. 4.EA GRITA –Laboratoire de pharmacologie, pharmacocinétique et pharmacie cliniqueUniv. LilleLilleFrance
  5. 5.Department of GeriatricsCHU LilleLilleFrance

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