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Prevalence and Determinants of Anticholinergic Medication Use in Elderly Dementia Patients

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Abstract

Background

People with dementia are sensitive to cognitive side effects of anticholinergic drugs. However, little is known about the prevalence of anticholinergic medications and its predictors in a nationally representative sample of community-based elderly dementia patients in the USA.

Objectives

The objectives of the study were to determine the prevalence and predictors of anticholinergic drugs use in elderly dementia patients.

Methods

The study involved retrospective analysis of the 2005–2009 Medical Expenditure Panel Surveys (MEPS), a nationally representative sample of the non-institutionalized US population. The study evaluated annual prevalence of anticholinergic drug use during the study period and factors associated with the use of anticholinergics among community-dwelling persons aged 65 and older with dementia. The anticholinergic drugs were identified using the Anticholinergic Drug Scale (ADS). Multiple logistic regression within the conceptual framework of the Anderson Behavioral Model was performed to identify predictors associated with clinically significant anticholinergic drug (ADS level 2 or 3) use.

Results

According to the MEPS, there were a total of 1.56 [95 % confidence interval (CI) 1.34, 1.73] million elderly dementia patients annually during the study period. Approximately, 23.3 % (95 % CI 19.2, 27.5) of elderly dementia patients used clinically significant anticholinergic agents (ADS level 2 or 3). Among the need factors, elderly dementia patients having mood disorders [odds ratio (OR) 2.19; 95 % CI 1.19, 4.06] and urinary incontinence (OR 6.58; 95 % CI 2.84, 15.29) were more likely to use drugs with clinically significant anticholinergic activities. Of the enabling factors, the odds of receiving higher-level anticholinergic drugs were significantly lower for patients who resided in the West region (OR 0.41; 95 % CI 0.17, 0.95) compared to the reference group, Northeast.

Conclusion

Over one in five elderly dementia patients used drugs with clinically significant anticholinergic effects. Mood disorder, urinary incontinence, and region were significantly associated with use of these drugs. Concerted efforts are needed to improve the quality of medication use by focusing on clinically significant anticholinergic agents.

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References

  1. Simonson W, Feinberg JL. Medication-related problems in the elderly: defining the issues and identifying solutions. Drugs Aging. 2005;22(7):559–69.

    Article  PubMed  Google Scholar 

  2. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–51.

    Article  PubMed  Google Scholar 

  3. Zhang M, Holman CD, Price SD, Sanfilippo FM, Preen DB, Bulsara MK. Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study. BMJ. 2009;338:a2752.

    Article  PubMed  Google Scholar 

  4. Hanlon JT, Fillenbaum GG, Schmader KE, Kuchibhatla M, Horner RD. Inappropriate drug use among community-dwelling elderly. Pharmacotherapy. 2000;20(5):575–82.

    Article  PubMed  CAS  Google Scholar 

  5. Curtis LH, Ostbye T, Sendersky V, Hutchison S, Dans PE, Wright A, et al. Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Intern Med. 2004;164(15):1621–5.

    Article  PubMed  Google Scholar 

  6. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.

    Article  PubMed  Google Scholar 

  7. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.

    Google Scholar 

  8. Fibiger HC, Damsma G, Day JC. Behavioral pharmacology and biochemistry of central cholinergic neurotransmission. Adv Exp Med Biol. 1991;295:399–414.

    Article  PubMed  CAS  Google Scholar 

  9. Peters NL. Snipping the thread of life. Antimuscarinic side effects of medications in the elderly. Arch Intern Med. 1989;149(11):2414–20.

    Article  PubMed  CAS  Google Scholar 

  10. Feinberg M. The problems of anticholinergic adverse effects in older patients. Drugs Aging. 1993;3(4):335–48.

    Article  PubMed  CAS  Google Scholar 

  11. Lieberman JA 3rd. Managing anticholinergic side effects. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):20–3.

    PubMed  Google Scholar 

  12. Rochon PA, Gurwitz JH. Drug therapy. Lancet. 1995;346(8966):32–6.

    Article  PubMed  CAS  Google Scholar 

  13. Flaherty JH. Psychotherapeutic agents in older adults. Commonly prescribed and over-the-counter remedies: causes of confusion. Clin Geriatr Med. 1998;14(1):101–27.

    PubMed  CAS  Google Scholar 

  14. Gray SL, Lai KV, Larson EB. Drug-induced cognition disorders in the elderly: incidence, prevention and management. Drug Saf. 1999;21(2):101–22.

    Article  PubMed  CAS  Google Scholar 

  15. Moore AR, O’Keeffe ST. Drug-induced cognitive impairment in the elderly. Drugs Aging. 1999;15(1):15–28.

    Article  PubMed  CAS  Google Scholar 

  16. Schliebs R, Arendt T. The cholinergic system in aging and neuronal degeneration. Behav Brain Res. 2011;221(2):555–63.

    Article  PubMed  CAS  Google Scholar 

  17. Sunderland T, Tariot P, Murphy DL, Weingartner H, Mueller EA, Cohen RM. Scopolamine challenges in Alzheimer’s disease. Psychopharmacology (Berl). 1985;87(2):247–9.

    Article  CAS  Google Scholar 

  18. Sunderland T, Tariot PN, Cohen RM, Weingartner H, Mueller EA 3rd, Murphy DL. Anticholinergic sensitivity in patients with dementia of the Alzheimer type and age-matched controls. A dose-response study. Arch Gen Psychiatry. 1987;44(5):418–26.

    Article  PubMed  CAS  Google Scholar 

  19. Roe CM, Anderson MJ, Spivack B. Use of anticholinergic medications by older adults with dementia. J Am Geriatr Soc. 2002;50(5):836–42.

    Article  PubMed  Google Scholar 

  20. Carnahan RM, Lund BC, Perry PJ, Chrischilles EA. The concurrent use of anticholinergics and cholinesterase inhibitors: rare event or common practice? J Am Geriatr Soc. 2004;52(12):2082–7.

    Article  PubMed  Google Scholar 

  21. Chatterjee S, Mehta S, Sherer JT, Aparasu RR. Prevalence and predictors of anticholinergic medication use in elderly nursing home residents with dementia: analysis of data from the 2004 National Nursing Home Survey. Drugs Aging. 2010;27(12):987–97.

    Article  PubMed  Google Scholar 

  22. Bhattacharya R, Chatterjee S, Carnahan RM, Aparasu RR. Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia. Am J Geriatr Pharmacother. 2011;9(6):434–41.

    Article  PubMed  CAS  Google Scholar 

  23. Cohen JW, Cohen SB, Banthin JS. The medical expenditure panel survey: a national information resource to support healthcare cost research and inform policy and practice. Med Care. 2009;47(7 Suppl 1):S44–50.

    Article  PubMed  Google Scholar 

  24. Medical Expenditure Panel Survey. Agency for Healthcare Research and Quality (AHRQ) (Online). http://meps.ahrq.gov/mepsweb/index.jsp. Accessed 25 Aug 2012.

  25. Kamble P, Chen H, Sherer JT, Aparasu RR. Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of National Survey Data. Drugs Aging. 2009;26(6):483–92.

    Article  PubMed  Google Scholar 

  26. 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(12):1481–6.

    Article  PubMed  CAS  Google Scholar 

  27. Modi A, Weiner M, Craig BA, Sands LP, Rosenman MB, Thomas J 3rd. Concomitant use of anticholinergics with acetylcholinesterase inhibitors in Medicaid recipients with dementia and residing in nursing homes. J Am Geriatr Soc. 2009;57(7):1238–44.

    Article  PubMed  Google Scholar 

  28. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973;51(1):95–124.

    Article  PubMed  CAS  Google Scholar 

  29. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.

    Article  PubMed  CAS  Google Scholar 

  30. Rosen RC, Zozula R, Jahn EG, Carson JL. Low rates of recognition of sleep disorders in primary care: comparison of a community-based versus clinical academic setting. Sleep Med. 2001;2(1):47–55.

    Article  PubMed  Google Scholar 

  31. Kemper RF, Steiner V, Hicks B, Pierce L, Iwuagwu C. Anticholinergic medications: use among older adults with memory problems. J Gerontol Nurs. 2007;33(1):21–9 (quiz 30–1).

    PubMed  Google Scholar 

  32. Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168(5):508–13.

    Article  PubMed  Google Scholar 

  33. Edwards KR, O’Connor JT. Risk of delirium with concomitant use of tolterodine and acetylcholinesterase inhibitors. J Am Geriatr Soc. 2002;50(6):1165–6.

    Article  PubMed  Google Scholar 

  34. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med. 1997;157(14):1531–6.

    Article  PubMed  CAS  Google Scholar 

  35. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991;151(9):1825–32.

    Article  PubMed  CAS  Google Scholar 

  36. Jano E, Aparasu RR. Healthcare outcomes associated with Beers’ criteria: a systematic review. Ann Pharmacother. 2007;41(3):438–47.

    Article  PubMed  Google Scholar 

  37. Lau DT, Kasper JD, Potter DE, Lyles A. Potentially inappropriate medication prescriptions among elderly nursing home residents: their scope and associated resident and facility characteristics. Health Serv Res. 2004;39(5):1257–76.

    Article  PubMed  Google Scholar 

  38. Shrank WH, Polinski JM, Avorn J. Quality indicators for medication use in vulnerable elders. J Am Geriatr Soc. 2007;55(Suppl 2):S373–82.

    Article  PubMed  Google Scholar 

  39. Zhang Y, Baicker K, Newhouse JP. Geographic variation in the quality of prescribing. N Engl J Med. 2010;363(21):1985–8.

    Article  PubMed  CAS  Google Scholar 

  40. Qato DM, Trivedi AN. Receipt of high risk medications among elderly enrollees in Medicare Advantage plans. J Gen Intern Med. 2013;28(4):546–53.

    Article  PubMed  Google Scholar 

  41. Meyers BS. Depression and dementia: comorbidities, identification, and treatment. J Geriatr Psychiatry Neurol. 1998;11(4):201–5.

    PubMed  CAS  Google Scholar 

  42. Katz IR, Sands LP, Bilker W, DiFilippo S, Boyce A, D’Angelo K. Identification of medications that cause cognitive impairment in older people: the case of oxybutynin chloride. J Am Geriatr Soc. 1998;46(1):8–13.

    PubMed  CAS  Google Scholar 

  43. Lipton RB, Kolodner K, Wesnes K. Assessment of cognitive function of the elderly population: effects of darifenacin. J Urol. 2005;173(2):493–8.

    Article  PubMed  Google Scholar 

  44. Kay GG, Ebinger U. Preserving cognitive function for patients with overactive bladder: evidence for a differential effect with darifenacin. Int J Clin Pract. 2008;62(11):1792–800.

    Article  PubMed  CAS  Google Scholar 

  45. Specht JK. Promoting continence in individuals with dementia. J Gerontol Nurs. 2011;37(2):17–21.

    Article  PubMed  Google Scholar 

  46. Hagglund D. A systematic literature review of incontinence care for persons with dementia: the research evidence. J Clin Nurs. 2010;19(3–4):303–12.

    Google Scholar 

  47. Gill SS, Mamdani M, Naglie G, Streiner DL, Bronskill SE, Kopp A, et al. A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med. 2005;165(7):808–13.

    Article  PubMed  Google Scholar 

  48. Antivert (package insert). New York: Pfizer, Inc; 2006.

  49. Forrester CM, Benfield DA Jr, Matern CE, Kelly JA, Pellegrini JE. Meclizine in combination with ondansetron for prevention of postoperative nausea and vomiting in a high-risk population. AANA J. 2007;75(1):27–33.

    PubMed  Google Scholar 

  50. Birks J. Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev. 2006(1):CD005593.

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Acknowledgements

The authors would like to thank Ms. Satabdi Chatterjee for editorial assistance. All authors disclose no conflict of interest. No funding was received for the study.

Financial Disclosure

The authors have no relevant financial interest to declare for the study.

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Authors and Affiliations

  1. Department of Clinical Sciences and Administration, College of Pharmacy, Texas Medical Center, University of Houston, 1441 Moursund Street, Houston, TX, 77030, USA

    Sneha D. Sura, Hua Chen & Rajender R. Aparasu

  2. Department of Epidemiology, Healthcare Effectiveness Research Center, Iowa Geriatric Education Center, The University of Iowa, College of Public Health, S161 CPHB, 105 River St., Iowa City, IA, 52242, USA

    Ryan M. Carnahan

Authors
  1. Sneha D. Sura
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  2. Ryan M. Carnahan
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  4. Rajender R. Aparasu
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Correspondence to Rajender R. Aparasu.

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Sura, S.D., Carnahan, R.M., Chen, H. et al. Prevalence and Determinants of Anticholinergic Medication Use in Elderly Dementia Patients. Drugs Aging 30, 837–844 (2013). https://doi.org/10.1007/s40266-013-0104-x

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