1
|
Kagota S, Futokoro R, Maruyama-Fumoto K, Chimoto J, Yamada S, Shinozuka K. Functional anticholinergic activity of drugs classified as strong and moderate on the anticholinergic burden scale on bladder and ileum. Basic Clin Pharmacol Toxicol 2024. [PMID: 39219245 DOI: 10.1111/bcpt.14071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 07/15/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
Several medications are commonly administered to older Japanese patients. Since some of them have not been included in previously developed scales to estimate the anticholinergic burden, we have developed a new muscarinic receptor binding-based anticholinergic burden scale. This study aimed to investigate the functional inhibitory effects of 60 medications, classified as anticholinergic burden scales 3 and 2 by the anticholinergic burden scale, on muscarinic receptor-mediated contractions in the bladder and ileum. The relaxation response induced by these drugs on isolated rat bladders and ileum smooth muscles constricted by carbachol was assessed using the organ bath method. All drugs inhibited smooth muscle contractile responses induced by the muscarinic receptor activation in a concentration-dependent manner in the rat bladder and ileum. Notably, variations were observed in the relaxation responses of the drugs, and the function EC50 values were positively correlated with the binding IC50 values in the bladder and ileum. The results of this study provide functional pharmacological evidence for the muscarinic receptor binding-based anticholinergic burden scale. Implementation of this scale may help reduce the risk of constipation and urinary retention, which are common side effects associated with anticholinergic drugs.
Collapse
Affiliation(s)
- Satomi Kagota
- Department of Pharmacology II, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
- Institute for Bioscience, Mukogawa Women's University, Nishinomiya, Japan
| | - Risa Futokoro
- Department of Pharmacology II, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Kana Maruyama-Fumoto
- Department of Pharmacology II, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Junko Chimoto
- Center for Pharma-Food Research (CPFR), Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Shizuo Yamada
- Center for Pharma-Food Research (CPFR), Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Kazumasa Shinozuka
- Department of Pharmacology II, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
| |
Collapse
|
2
|
Mahmoudi R, Greten S, Veith Sanches L, Krey L, Ulaganathan S, Höglinger GU, Heck J, Wegner F, Klietz M. Impact of the Anticholinergic Burden on Disease-Specific Symptoms in Parkinsonian Syndromes. Brain Sci 2024; 14:805. [PMID: 39199497 PMCID: PMC11352570 DOI: 10.3390/brainsci14080805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/01/2024] Open
Abstract
Background: Anticholinergic adverse effects pose a relevant threat to patients, in particular elderly and cognitively impaired patients. Patients with Parkinsonian syndromes are especially at risk from anticholinergic adverse effects due to the often-required complex drug therapy. Aims: The aim of this study was to evaluate the potential effect of the anticholinergic burden on motor and non-motor symptoms in Parkinson's disease and atypical Parkinsonian syndromes. Methods: This cross-sectional, monocentric retrospective data analysis included 151 patients with Parkinson's disease (PD), 63 with progressive supranuclear palsy (PSP), and 36 with multiple system atrophy (MSA). The anticholinergic burden of patients' medications was determined using two established scores: the Anticholinergic Drug Scale (ADS) and the German Anticholinergic Burden Scale (GABS). These scores were compared between the different diseases and correlated with several disease-specific scores. Results: Anticholinergic burden was higher in patients with PD, in particular, compared to PSP. In the PD group, anticholinergic burden showed a weak correlation with almost all analyzed clinical scores and the number of administered drugs. The UMSARS I and II showed a significant correlation with the anticholinergic burden in MSA patients. In general, the GABS-measured anticholinergic burden was significantly higher compared to the ADS-measured. Conclusions: The calculated anticholinergic burden affected motor and non-motor symptoms in patients with various Parkinsonian syndromes poorly. Since the GABS also contains basic anti-parkinsonian drugs, this score tended to overestimate the anticholinergic burden in patients with Parkinsonian syndromes and, therefore, seemed less appropriate for this application.
Collapse
Affiliation(s)
- Romina Mahmoudi
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (R.M.); (L.V.S.); (L.K.); (S.U.); (G.U.H.); (F.W.); (M.K.)
| | - Stephan Greten
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (R.M.); (L.V.S.); (L.K.); (S.U.); (G.U.H.); (F.W.); (M.K.)
| | - Linda Veith Sanches
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (R.M.); (L.V.S.); (L.K.); (S.U.); (G.U.H.); (F.W.); (M.K.)
| | - Lea Krey
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (R.M.); (L.V.S.); (L.K.); (S.U.); (G.U.H.); (F.W.); (M.K.)
| | - Sarana Ulaganathan
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (R.M.); (L.V.S.); (L.K.); (S.U.); (G.U.H.); (F.W.); (M.K.)
| | - Günter U. Höglinger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (R.M.); (L.V.S.); (L.K.); (S.U.); (G.U.H.); (F.W.); (M.K.)
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, 80539 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, 80539 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 80539 Munich, Germany
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany;
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (R.M.); (L.V.S.); (L.K.); (S.U.); (G.U.H.); (F.W.); (M.K.)
| | - Martin Klietz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (R.M.); (L.V.S.); (L.K.); (S.U.); (G.U.H.); (F.W.); (M.K.)
| |
Collapse
|
3
|
Wyman-Chick KA, Barrett MJ, Miller MJ, Kuntz JL, Chrenka EA, Rossom RC. Factors Associated With Increased Health Care Utilization for Patients With Dementia With Lewy Bodies: A Narrative Review. J Patient Cent Res Rev 2024; 11:97-106. [PMID: 39044852 PMCID: PMC11262839 DOI: 10.17294/2330-0698.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
Numerous studies have demonstrated that dementia is associated with increased utilization of health care services, which in turn results in increased costs of care. Dementia with Lewy bodies (DLB) is associated with greater costs of care relative to other forms of dementia due to higher rates of hospitalization and nursing home placement directly related to neuropsychiatric symptoms, parkinsonism, increased susceptibility to delirium, and elevated rates of caregiver burden. There is a critical need for researchers to identify potentially modifiable factors contributing to increased costs of care and poor clinical outcomes for patients with DLB, which may include comorbidities, polypharmacy/contraindicated medications, and access to specialty care. Previous research has utilized Medicare claims data, limiting the ability to study patients with early-onset (ie, prior to age 65) DLB. Integrated health systems offer the ability to combine electronic medical record data with Medicare, Medicaid, and commercial claims data and may therefore be ideal for utilization research in this population. The goals of this narrative review are to 1) synthesize and describe the current literature on health care utilization studies for patients with DLB, 2) highlight the current gaps in the literature, and 3) provide recommendations for stakeholders, including researchers, health systems, and policymakers. It is important to improve current understanding of potentially modifiable factors associated with increased costs of care among patients with DLB to inform public health policies and clinical decision-making, as this will ultimately improve the quality of patient care.
Collapse
Affiliation(s)
- Kathryn A. Wyman-Chick
- Neuropsychology, HealthPartners, St. Paul, MN
- Center for Memory and Aging, HealthPartners Institute, Minneapolis, MN
| | | | | | | | - Ella A. Chrenka
- Center for Memory and Aging, HealthPartners Institute, Minneapolis, MN
| | - Rebecca C. Rossom
- Center for Memory and Aging, HealthPartners Institute, Minneapolis, MN
| |
Collapse
|
4
|
Gebreyohannes EA, Shibe BS, Taye WA, Lee K, Abdela OA, Ayele EM, Belachew EA, Mengistu SB, Myint PK, Soiza RL. Anticholinergic burden and health-related quality of life among adult patients in a resource-limited setting: a cross-sectional study. Int J Clin Pharm 2024:10.1007/s11096-024-01769-z. [PMID: 39007992 DOI: 10.1007/s11096-024-01769-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Anticholinergic medications are now widely acknowledged for their unfavorable risk-to-benefit profile owing to their adverse effects. Health-related quality of life (HRQoL) is commonly regarded as a crucial person-centered outcome. AIM This study aimed to investigate the association between anticholinergic burden and HRQoL in hospitalized and ambulatory patients seen in Ethiopia. METHOD This cross-sectional study utilized a questionnaire and medical records to collect data from a convenience sample of adult patients attending both inpatient wards and ambulatory clinic of University of Gondar Comprehensive Specialized Hospital between April and September 2022. Anticholinergic burden was measured by anticholinergic cognitive burdens scale (ACBS), while HRQoL was measured using EQ5D-index (Euroqol-5 dimensions-5-Levels index) and EQ5D-VAS (visual analogue scale). Linear regression was used to assess the influence of high anticholinergic burden (ACBS score ≥ 3) on EQ5D-index and EQ5D-VAS, with adjustments made for sociodemographic and clinical confounders. RESULTS A total of 828 patients participated in this study (median (IQR) age was 45.0 (30, 60) and 55.9% were female). On multiple linear regression analysis, high anticholinergic burden was associated with a statistically significant decline in HRQoL, as evidenced by reductions in both EQ5D index (- 0.174 (- 0.250, - 0.098)) and EQ5D-VAS scores (- 9.4 (- 13.3, - 5.2)). CONCLUSION A significant association between high anticholinergic burden and diminished HRQoL was found among a relatively younger cohort in a resource-limited setting, even after adjustment for important confounding variables. Clinicians should be cognizant of the cumulative impact of anticholinergic burden on HRQoL outcomes and strive to minimize anticholinergic burden.
Collapse
Affiliation(s)
- Eyob Alemayehu Gebreyohannes
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia.
- School of Allied Health, The University of Western Australia, Perth, Australia.
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, The University of Aberdeen, Aberdeen, UK.
| | - Biniam Siyum Shibe
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Wagaye Atalay Taye
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Kenneth Lee
- School of Allied Health, The University of Western Australia, Perth, Australia
| | - Ousman Abubeker Abdela
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, The University of Aberdeen, Aberdeen, UK
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Emneteab Mesfin Ayele
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | | | - Phyo Kyaw Myint
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, The University of Aberdeen, Aberdeen, UK
| | - Roy Louis Soiza
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, The University of Aberdeen, Aberdeen, UK
| |
Collapse
|
5
|
Podesser F, Weninger J, Weiss EM, Marksteiner J, Canazei M. Short-Term Medication Effect on Fall Risk in Multimorbid Inpatients with Dementia. Gerontology 2024; 70:620-629. [PMID: 38626732 DOI: 10.1159/000538074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/25/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Dementia increases the risk of falls and fall-related injuries, which may be caused by inappropriate medication use. To date, there is little evidence on which medications are more likely to cause falls. We therefore investigated the effects of medication use and medication changes 48 h before falls in hospitalised patients with dementia. METHODS This matched case-control study included 74 patients with a mean age of 83 years (38% women) who had been hospitalised for at least 7 days. Information on medications, diagnoses, disease severity, use of walking aids, falls, and demographics was collected from electronic medical records. The effects of the number of medications and psychotropics, equivalent daily doses of antidepressants, antipsychotics and benzodiazepines, anticholinergic burden, medication initiation, dose change, medication discontinuation, as-needed medications, opioid use and the presence of fall-increasing diseases were examined separately for the periods 0 h-24 h and 24 h-48 h before the falls using binomial logistic regression analyses. RESULTS Falls increased significantly with higher daily antipsychotic doses 24 h before the fall. In addition, the rate of falls increased with higher anticholinergic burden and prevalence of medication discontinuation 24-48 h before the fall. Notably, the total number of medications and psychotropic medications had no effect on the incidence of falls. CONCLUSION With regard to the short-term effects of medication on fall risk, particular attention should be paid to the daily dose of antipsychotics, anticholinergic burden and medication discontinuation. Further studies with larger samples are needed to confirm the results of this study.
Collapse
Affiliation(s)
| | - Johannes Weninger
- Research and Development Department, Bartenbach GmbH, Aldrans, Austria
| | - Elisabeth M Weiss
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, Hall in Tyrol, Austria
| | - Markus Canazei
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
6
|
Vanegas-Arroyave N, Caroff SN, Citrome L, Crasta J, McIntyre RS, Meyer JM, Patel A, Smith JM, Farahmand K, Manahan R, Lundt L, Cicero SA. An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders. CNS Drugs 2024; 38:239-254. [PMID: 38502289 PMCID: PMC10980662 DOI: 10.1007/s40263-024-01078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
Drug-induced movement disorders (DIMDs) are associated with use of dopamine receptor blocking agents (DRBAs), including antipsychotics. The most common forms are drug-induced parkinsonism (DIP), dystonia, akathisia, and tardive dyskinesia (TD). Although rare, neuroleptic malignant syndrome (NMS) is a potentially life-threatening consequence of DRBA exposure. Recommendations for anticholinergic use in patients with DIMDs were developed on the basis of a roundtable discussion with healthcare professionals with extensive expertise in DIMD management, along with a comprehensive literature review. The roundtable agreed that "extrapyramidal symptoms" is a non-specific term that encompasses a range of abnormal movements. As such, it contributes to a misconception that all DIMDs can be treated in the same way, potentially leading to the misuse and overprescribing of anticholinergics. DIMDs are neurobiologically and clinically distinct, with different treatment paradigms and varying levels of evidence for anticholinergic use. Whereas evidence indicates anticholinergics can be effective for DIP and dystonia, they are not recommended for TD, akathisia, or NMS; nor are they supported for preventing DIMDs except in individuals at high risk for acute dystonia. Anticholinergics may induce serious peripheral adverse effects (e.g., urinary retention) and central effects (e.g., impaired cognition), all of which can be highly concerning especially in older adults. Appropriate use of anticholinergics therefore requires careful consideration of the evidence for efficacy (e.g., supportive for DIP but not TD) and the risks for serious adverse events. If used, anticholinergic medications should be prescribed at the lowest effective dose and for limited periods of time. When discontinued, they should be tapered gradually.
Collapse
Affiliation(s)
- Nora Vanegas-Arroyave
- Department of Neurology, Baylor College of Medicine, 7200 Cambridge Street, Suite 9A, Houston, TX, 77030, USA.
| | - Stanley N Caroff
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Jonathan M Meyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Amita Patel
- Dayton Psychiatric Associations, Dayton, OH, USA
- Joint Township District Memorial Hospital, St. Marys, OH, USA
| | | | | | | | | | | |
Collapse
|
7
|
McQuaid GA, Duane SC, Ahmed N, Lee NR, Charlton R, Wallace GL. Increased anticholinergic medication use in middle-aged and older autistic adults and its associations with self-reported memory difficulties and cognitive decline. Autism Res 2024; 17:852-867. [PMID: 38108575 PMCID: PMC11332248 DOI: 10.1002/aur.3076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
Many commonly used prescription and over-the-counter medicines have potent anticholinergic (AC) effects. Among older adults, AC medications are associated with cognitive impairment and risk for cognitive disorders, including Alzheimer's disease. Collectively, the impact of AC medications is known as anticholinergic cognitive burden (ACB). Because of the high rates of co-occurring medical and psychiatric conditions, autistic adults may have high AC exposure and, thus, may experience elevated ACB. However, no research has characterized AC exposure or examined its associations with cognitive outcomes in autistic adults. Autistic adults (40-83 years) recruited via Simons Powering Autism Research's (SPARK) Research Match service self-reported their medication use (N = 415) and memory complaints (N = 382) at Time (T)1. At T2, 2 years later, a subset of T1 participants (N = 197) self-reported on decline in cognition. Medications were coded using two scales of AC potency. A high proportion (48.2%-62.9%, depending upon the AC potency scale) of autistic adults reported taking at least one medication with AC effects, and 20.5% to 26.5% of autistic adults reported clinically-relevant levels of AC medication (potency ≥3). After controlling for birth-sex, and age, hierarchical linear regression models showed total ACB scores and AC potency values of ≥3 predicted greater memory complaints. Logistic regression models showed that AC medicines at T1 were associated with self-reported cognitive decline at follow-up 2 years later. Understanding AC medications-including potentially earlier AC polypharmacy-and their impacts on cognition (e.g., dementia risk) in autistic adults is warranted.
Collapse
Affiliation(s)
- Goldie A McQuaid
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Sean C Duane
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Neha Ahmed
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Nancy Raitano Lee
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rebecca Charlton
- Department of Psychology, Goldsmiths University of London, London, UK
| | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, District of Columbia, USA
| |
Collapse
|
8
|
Sargent L, Zimmerman KM, Mohammed A, Barrett MJ, Nawaz H, Wyman-Chick K, Mackiewicz M, Roman Y, Slattum P, Russell S, Dixon DL, Lageman SK, Hobgood S, Thacker LR, Price ET. Low-Income Older Adults' Vulnerability to Anticholinergic Medication-Associated Frailty. Drugs Aging 2023; 40:1123-1131. [PMID: 37856064 DOI: 10.1007/s40266-023-01069-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND A growing body of research supports the negative impact of anticholinergic drug burden on physical frailty. However, prior research has been limited to homogeneous white European populations, and few studies have evaluated how anticholinergic burden tools compare in their measurement function and reliability with minority community-dwelling adult populations. This study investigated the association between anticholinergic drug exposure and frailty by conducting a sensitivity analysis using multiple anticholinergic burden tools in a diverse cohort. METHODS A comprehensive psychometric approach was used to assess the performance of five clinical Anticholinergic Burden Tools: Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), average daily dose, total standardized daily doses (TSDD), and Cumulative Anticholinergic Burden scale (CAB). Spearman correlation matrix and intraclass correlation coefficients (ICC) were used to determine the association among the variables. Ordinal logistic regression is used to evaluate the anticholinergic burden measured by each scale to determine the prediction of frailty. Model performance is determined by the area under the curve (AUC). RESULTS The cohort included 80 individuals (mean age 69 years; 55.7% female, 71% African American). All anticholinergic burden tools were highly correlated (p < 0.001), ICC3 0.66 (p < 0.001, 95% confidence interval (CI) 0.53-0.73). Among individuals prescribed anticholinergics, 33% were robust, 44% were prefrail, and 23% were frail. All five tools predicted prefrail and frail status (p < 0.05) with low model misclassification rates for frail individuals (AUC range 0.78-0.85). CONCLUSION Anticholinergic burden tools evaluated in this cohort of low-income African American older adults were highly correlated and predicted prefrail and frail status. Findings indicate that clinicians can select the appropriate instrument for the clinic setting and research question while maintaining confidence that all five tools will produce reliable results. Future anticholinergic research is needed to unravel the association between interventions such as deprescribing on incident frailty in longitudinal data.
Collapse
Affiliation(s)
- Lana Sargent
- School of Nursing, Virginia Commonwealth University, 1100 E Leigh St., Richmond, VA, 23298, USA.
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA.
- Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA.
| | - Kristin M Zimmerman
- Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
| | - Almutairi Mohammed
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, 51452, Buraydah, Saudi Arabia
| | - Matthew J Barrett
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Huma Nawaz
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | | | - Marissa Mackiewicz
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
- Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA
| | - Youssef Roman
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
| | - Patricia Slattum
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
- Virginia Center on Aging, Virginia Commonwealth University, 900 E Leigh St, Richmond, VA, 23298, USA
| | - Sally Russell
- School of Nursing, Virginia Commonwealth University, 1100 E Leigh St., Richmond, VA, 23298, USA
| | - Dave L Dixon
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
| | - Sarah K Lageman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Sarah Hobgood
- School of Medicine, Department of Geriatrics, Virginia Commonwealth University, 1101 E. Marshall St., Richmond, VA, 23298, USA
| | - Leroy R Thacker
- School of Medicine, Department of Biostatistics, Virginia Commonwealth University, 830 East Main Street, Richmond, VA, 23298, USA
| | - Elvin T Price
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
- Institute for Inclusion, Inquiry, and Innovation (iCubed): Health and Wellness in Aging Populations Core, Richmond, VA, 23298, USA
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St., Richmond, VA, 23298, USA
| |
Collapse
|
9
|
Wong HL, Mandal AKJ, Weaver C, Chauhan R, Missouris CG. Polypharmacy and associated cumulative anticholinergic burden are important predictors of falls risk. Br J Clin Pharmacol 2023; 89:2332-2333. [PMID: 37137729 DOI: 10.1111/bcp.15753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Ho Lun Wong
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | | | - Claire Weaver
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | - Rahul Chauhan
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | - Constantinos G Missouris
- Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
- University of Nicosia Medical School, Nicosia, Cyprus
| |
Collapse
|
10
|
Roitto HM, Aalto UL, Öhman H, Saarela RKT, Kautiainen H, Salminen K, Pitkälä KH. Association of medication use with falls and mortality among long-term care residents: a longitudinal cohort study. BMC Geriatr 2023; 23:375. [PMID: 37331981 DOI: 10.1186/s12877-023-04096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/07/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Falls in long-term care are common. The aim of our study was to explore how medication use is associated with incidence of falls, related consequences, and all-cause mortality among long-term care residents. METHODS Five hundred thirty two long-term care residents aged 65 years or older participated in this longitudinal cohort study in 2018-2021. Data on medication use were retrieved from medical records. Polypharmacy was defined as use of 5-10 medications and excessive polypharmacy as use of > 10 medications. The numbers of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment. Participants were followed for three years for mortality. All analysis were adjusted for age, sex, Charlson Comorbidity Index, Clinical dementia rating, and mobility. RESULTS A total of 606 falls occurred during the follow-up. Falls increased significantly with the number of medications used. Fall rate was 0.84/person-years (pyrs) (95% CI 0.56 to 1.13) for the non-polypharmacy group, 1.13/pyrs (95% CI 1.01 to 1.26) for the polypharmacy group, and 1.84/pyrs (95% CI 1.60 to 2.09) for the excessive polypharmacy group. Incidence rate ratio for falls was 1.73 (95% CI 1.44 to 2.10) for opioids, 1.48 (95% CI 1.23 to 1.78) for anticholinergic medication, 0.93 (95% CI 0.70 to 1.25) for psychotropics, and 0.91 (95% CI 0.77 to 1.08) for Alzheimer medication. The three-year follow-up showed significant differences in mortality between the groups, the lowest survival rate (25%) being in the excessive polypharmacy group. CONCLUSION Polypharmacy, opioid and anticholinergic medication use predicted incidence of falls in long-term care. The use of more than 10 medications predicted all-cause mortality. Special attention should be paid to both number and type of medications when prescribing in long-term care.
Collapse
Affiliation(s)
- Hanna-Maria Roitto
- Department of Geriatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- Finnish Institute for Health and Welfare, Population Health Unit, Helsinki, Finland.
- Department of Social Services and Health Care, Helsinki, Finland.
| | - Ulla L Aalto
- Department of Geriatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Öhman
- Department of Geriatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Karoliina Salminen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| |
Collapse
|
11
|
Gallagher E, Mehmood M, Lavan A, Kenny RA, Briggs R. Psychotropic medication use and future unexplained and injurious falls and fracture amongst community-dwelling older people: data from TILDA. Eur Geriatr Med 2023:10.1007/s41999-023-00786-x. [PMID: 37157012 DOI: 10.1007/s41999-023-00786-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/13/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Psychotropic medications (antidepressants, anticholinergics, benzodiazepines, 'Z'-drugs and antipsychotics) are frequently identified as Falls Risk Increasing Drugs. The aim of this study is to clarify the association of psychotropic medication use with future falls/fracture amongst community-dwelling older people. METHODS Participants ≥ 65 years from TILDA were included and followed from Waves 1 to 5 (8-year follow-up). Incidence of falls (total falls/unexplained/injurious) and fracture was by self-report; unexplained falls were falls not caused by a slip/trip, with no apparent cause. Poisson regression models reporting incidence rate ratios (IRR) assessed the association between medications and future falls/fracture, adjusted for relevant covariates. RESULTS Of 2809 participants (mean age 73 years), 15% were taking ≥ 1 psychotropic medication. During follow-up, over half of participants fell, with 1/3 reporting injurious falls, over 1/5 reporting unexplained falls and almost 1/5 reporting fracture. Psychotropic medications were independently associated with falls [IRR 1.15 (95% CI 1.00-1.31)] and unexplained falls [IRR 1.46 (95% CI 1.20-1.78)]. Taking ≥ 2 psychotropic medications was further associated with future fracture (IRR 1.47 (95% CI 1.06-2.05)]. Antidepressants were independently associated with falls [IRR 1.20 (1.00-1.42)] and unexplained falls [IRR 2.12 (95% CI 1.69-2.65)]. Anticholinergics were associated with unexplained falls [IRR 1.53 (95% CI 1.14-2.05)]. 'Z'-drug and benzodiazepine use were not associated with falls or fractures. CONCLUSION Psychotropic medications, particularly antidepressants and anticholinergic medications, are independently associated with falls and fractures. Regular review of ongoing need for these medications should therefore be central to the comprehensive geriatric assessment.
Collapse
Affiliation(s)
- Eleanor Gallagher
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Mustafa Mehmood
- Department of Emergency Medicine, St James's Hospital, Dublin, Ireland
| | - Amanda Lavan
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Robert Briggs
- Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland.
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland.
| |
Collapse
|
12
|
Wong HL, Weaver C, Marsh L, Mon KO, Dapito JM, Amin FR, Chauhan R, Mandal AKJ, Missouris CG. Polypharmacy and cumulative anticholinergic burden in older adults hospitalized with fall. Aging Med (Milton) 2023. [DOI: 10.1002/agm2.12250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Affiliation(s)
- Ho Lun Wong
- Wexham Park Hospital, Frimley Health NHS Trust Slough UK
| | - Claire Weaver
- Wexham Park Hospital, Frimley Health NHS Trust Slough UK
| | - Lauren Marsh
- Wexham Park Hospital, Frimley Health NHS Trust Slough UK
| | - Khine Oo Mon
- Wexham Park Hospital, Frimley Health NHS Trust Slough UK
| | - John M. Dapito
- Wexham Park Hospital, Frimley Health NHS Trust Slough UK
| | - Fouad R. Amin
- Wexham Park Hospital, Frimley Health NHS Trust Slough UK
- Al Azhar University Cairo Egypt
| | - Rahul Chauhan
- Wexham Park Hospital, Frimley Health NHS Trust Slough UK
| | | | - Constantinos G. Missouris
- Wexham Park Hospital, Frimley Health NHS Trust Slough UK
- University of Nicosia Medical School Nicosia Cyprus
| |
Collapse
|
13
|
Glaser I. [Polypharmacy and Delirium in the Elderly]. PRAXIS 2023; 112:335-339. [PMID: 37042399 DOI: 10.1024/1661-8157/a003998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Polypharmacy and Delirium in the Elderly Abstract: Delirium often occurs in elderly hospitalized patients. Multimorbidity and associated polypharmacy are known risk factors for developing delirium. Moreover, delirium itself often leads to the prescription of additional drugs. This article aims to enlighten the interrelation of delirium and polypharmacy in the context of recent evidence. It also tries to show possibilities of deprescribing.
Collapse
|
14
|
Knight EM. Tizanidine: An overlooked alternative muscle relaxant for older patients. J Am Geriatr Soc 2023; 71:679-682. [PMID: 36314387 DOI: 10.1111/jgs.18111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 02/17/2023]
Affiliation(s)
- Emmanuel M Knight
- Department of Pharmaceutical Services, University of California Los Angeles, Santa Monica Medical Center, Santa Monica, California, USA
| |
Collapse
|
15
|
Dinh TS, Meid AD, Rudolf H, Brueckle MS, González-González AI, Bencheva V, Gogolin M, Snell KIE, Elders PJM, Thuermann PA, Donner-Banzhoff N, Blom JW, van den Akker M, Gerlach FM, Harder S, Thiem U, Glasziou PP, Haefeli WE, Muth C. Anticholinergic burden measures, symptoms, and fall-associated risk in older adults with polypharmacy: Development and validation of a prognostic model. PLoS One 2023; 18:e0280907. [PMID: 36689445 PMCID: PMC9870119 DOI: 10.1371/journal.pone.0280907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/22/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Anticholinergic burden has been associated with adverse outcomes such as falls. To date, no gold standard measure has been identified to assess anticholinergic burden, and no conclusion has been drawn on which of the different measure algorithms best predicts falls in older patients from general practice. This study compared the ability of five measures of anticholinergic burden to predict falls. To account for patients' individual susceptibility to medications, the added predictive value of typical anticholinergic symptoms was further quantified in this context. METHODS AND FINDINGS To predict falls, models were developed and validated based on logistic regression models created using data from two German cluster-randomized controlled trials. The outcome was defined as "≥ 1 fall" vs. "no fall" within a 6-month follow-up period. Data from the RIME study (n = 1,197) were used in model development, and from PRIMUM (n = 502) for external validation. The models were developed step-wise in order to quantify the predictive ability of anticholinergic burden measures, and anticholinergic symptoms. In the development set, 1,015 patients had complete data and 188 (18.5%) experienced ≥ 1 fall within the 6-month follow-up period. The overall predictive value of the five anticholinergic measures was limited, with neither the employed anticholinergic variable (binary / count / burden), nor dose-dependent or dose-independent measures differing significantly in their ability to predict falls. The highest c-statistic was obtained using the German Anticholinergic Burden Score (0.73), whereby the optimism-corrected c-statistic was 0.71 after interval validation using bootstrapping and 0.63 in the external validation. Previous falls and dizziness / vertigo had the strongest prognostic value in all models. CONCLUSIONS The ability of anticholinergic burden measures to predict falls does not appear to differ significantly, and the added value they contribute to risk classification in fall-prediction models is limited. Previous falls and dizziness / vertigo contributed most to model performance.
Collapse
Affiliation(s)
- Truc Sophia Dinh
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas D. Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Maria-Sophie Brueckle
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Veronika Bencheva
- HELIOS University Clinic Wuppertal, Philipp Klee-Institute for Clinical Pharmacology, University of Witten / Herdecke, Witten, Germany
| | - Matthias Gogolin
- HELIOS University Clinic Wuppertal, Philipp Klee-Institute for Clinical Pharmacology, University of Witten / Herdecke, Witten, Germany
| | - Kym I. E. Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Petra J. M. Elders
- Amsterdam UMC, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Petra A. Thuermann
- HELIOS University Clinic Wuppertal, Philipp Klee-Institute for Clinical Pharmacology, University of Witten / Herdecke, Witten, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice / Family Medicine, Philipps University Marburg, Marburg, Germany
| | - Jeanet W. Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjan van den Akker
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium
| | - Ferdinand M. Gerlach
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Harder
- Institute of Clinical Pharmacology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrich Thiem
- Department of Geriatrics, Immanuel Albertinen Diakonie, Albertinen-Haus, Hamburg, Germany
- University Clinic Eppendorf, Hamburg, Germany
| | - Paul P. Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christiane Muth
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of General Practice and Family Medicine, Medical Faculty East-Westphalia, University of Bielefeld, Bielefeld, Germany
| |
Collapse
|
16
|
Abadir A, Dalton R, Zheng W, Pincavitch J, Tripathi R. Neuroleptic Sensitivity in Dementia with Lewy Body and Use of Pimavanserin in an Inpatient Setting: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2022; 23:e937397. [PMID: 36282782 PMCID: PMC9619381 DOI: 10.12659/ajcr.937397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/20/2022] [Accepted: 09/08/2022] [Indexed: 11/04/2023]
Abstract
BACKGROUND Antidopaminergic medications, including antipsychotics, are known to worsen motor and neuropsychiatric symptoms, including cognition and psychosis, in patients with dementia with Lewy body (DLB). The intensity of worsened clinical symptoms may vary and can result in mortality in certain situations. There have been some reports supporting clozapine, quetiapine and pimavanserin use in psychosis control in this population. CASE REPORT We describe the case of 75-year-old man with diagnosis of DLB and the post-treatment outcome with olanzapine for psychosis during hospitalization. He experienced worsened cognitive and motor functions. Discontinuation of olanzapine resulted in resolution of the clinical worsening. Further, re-initiation of Pimavanserin helped treat his hallucinations. He returned back to his baseline during a follow-up visit in the clinic at 1 month after discharge. Further, we incorporated the use of Best Practice Alert (BPA) as a part of the electronic health record (EHR) system to help providers identify patients prone to neuroleptic sensitivity and help select appropriate medications to treat psychosis in this patient population. CONCLUSIONS Administration of antipsychotics in patients with parkinsonism, especially DLB, requires close clinical monitoring and judicious use. Awareness of morbidity and mortality associated with such use is of importance, especially during hospitalization. From our experience, we incorporated use of BPA, which can help providers make judicious choices while treating this patient population. Pimavanserin, which is FDA-approved for psychosis in Parkinson's disease, could be a potential safe and effective treatment option in this patient population.
Collapse
Affiliation(s)
- Anthony Abadir
- Department of Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Ryder Dalton
- West Virginia School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Wanhong Zheng
- Department of Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Jami Pincavitch
- Department of Orthopedics, West Virginia University, Morgantown, WV, USA
| | - Richa Tripathi
- Department of Neurology, West Virginia University, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| |
Collapse
|
17
|
Balasundaram B, Ang WST, Stewart R, Bishara D, Ooi CH, Li F, Akram F, Eu Kwek AB. Improving quantification of anticholinergic burden using the Anticholinergic Effect on Cognition Scale - a healthcare improvement study in a geriatric ward setting. Australas Psychiatry 2022; 30:535-540. [PMID: 35726508 PMCID: PMC9379386 DOI: 10.1177/10398562221103117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Anticholinergic burden refers to the cumulative effects of taking multiple medications with anticholinergic effects. This study was carried out in a public hospital in Singapore, aimed to improve and achieve a 100% comprehensive identification and review of measured, anticholinergic burden in a geriatric psychiatry liaison service to geriatric wards. We evaluated changes in pre-to post-assessment anticholinergic burden scores and trainee feedback. METHOD Plan Do Study Act methodology was employed, and Anticholinergic Effect on Cognition scale (AEC) was implemented as the study intervention. A survey instrument evaluated trainee feedback. RESULTS There was no measured anticholinergic burden in a baseline of 170 assessments. 75 liaison psychiatry assessments were conducted between June and November 2021 in two cycles. 94.7% of pre-assessments (at the time of assessment) and 71.1% of post-assessments (following assessment) had a record of AEC scores in clinical documentation in cycle one, improving in the second cycle to 100%, 94.6%, respectively. A high post-assessment AEC score of 3 and over reduced from 15.8% in cycle one to 5.4% in cycle two. The trainee feedback suggested an enriching educational experience. CONCLUSIONS Using the AEC scale, the findings support the feasibility of comprehensive identification and review of measured anticholinergic burden in older people with neurocognitive disorders.
Collapse
Affiliation(s)
| | | | - Robert Stewart
- Department of Psychological Medicine, 34426Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Delia Bishara
- Department of Psychological Medicine, Kings College London, Institute of Psychiatry, Psychology and Neuroscience, Mental Health of Older Adults & Dementia, 4958South London & Maudsley NHS Foundation Trust, London, UK
| | - Chun How Ooi
- Department of Geriatric Medicine, 26674Changi General Hospital, Singapore
| | - Fuyin Li
- Advanced Practice Nurse Development, Department of Nursing, 26674Changi General Hospital, Singapore
| | - Farooq Akram
- Department of Internal Medicine, 26674Changi General Hospital, Singapore
| | | |
Collapse
|
18
|
Silva-Almodóvar A, Nahata MC. Clinical Utility of Medication-Based Risk Scores to Reduce Polypharmacy and Potentially Avoidable Healthcare Utilization. Pharmaceuticals (Basel) 2022; 15:ph15060681. [PMID: 35745600 PMCID: PMC9231366 DOI: 10.3390/ph15060681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 12/26/2022] Open
Abstract
The management of multiple chronic health conditions often requires patients to be exposed to polypharmacy to improve their health and enhance their quality of life. However, exposure to polypharmacy has been associated with an increased risk for adverse effects, drug-drug interactions, inappropriate prescribing, medication nonadherence, increased healthcare utilization such as emergency department visits and hospitalizations, and costs. Medication-based risk scores have been utilized to identify patients who may benefit from deprescribing interventions and reduce rates of inappropriate prescribing. These risk scores may also be utilized to prompt targeted discussions between patients and providers regarding medications or medication classes contributing to an individual’s risk for harm, eventually leading to the deprescribing of the offending medication(s). This opinion will describe existing medication-based risk scores in the literature, their utility in identifying patients at risk for specific adverse events, and how they may be incorporated in healthcare settings to reduce rates of potentially inappropriate polypharmacy and avoidable healthcare utilization and costs.
Collapse
Affiliation(s)
- Armando Silva-Almodóvar
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
- Tabula Rasa HealthCare, Tucson, AZ 85701, USA
| | - Milap C. Nahata
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
- College of Medicine, Ohio State University, Columbus, OH 43210, USA
- Correspondence: ; Tel.: +1-614-292-2472
| |
Collapse
|
19
|
Jung YS, Suh D, Choi HS, Park HD, Jung SY, Suh DC. Risk of Fall-Related Injuries Associated with Antidepressant Use in Elderly Patients: A Nationwide Matched Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042298. [PMID: 35206480 PMCID: PMC8872471 DOI: 10.3390/ijerph19042298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/25/2022]
Abstract
Previous studies have reported a higher risk of falls among tricyclic antidepressant (TCA) users compared to selective serotonin reuptake inhibitor (SSRI) users, yet SSRIs are known as a safer antidepressant class for use in older adults. This study examined the effects of antidepressant use on the risk of fall-related injuries after classifying antidepressant drugs, polypharmacy, and central nervous system (CNS) drugs by therapeutic classes and identifying factors influencing risk of fall-related injuries. A retrospective matched cohort study based on propensity scores was conducted among older adults, aged 70–89 years, who initiated antidepressant use between 1 January 2012 and 31 December 2014 using the national health insurance system senior cohort in Korea. The proportional hazard Cox regression model was used to examine the association between fall-related injuries and antidepressants. The subgroup analyses were performed to assess the risk of fall-related injuries by the number of concurrently administered medications, therapeutic classes of antidepressants, and CNS class medications. This study found that duloxetine, escitalopram, paroxetine, amitriptyline, imipramine, and trazodone significantly increased the risk of fall-related injuries in older adults. When antidepressants were prescribed to older adults, prescribers carefully considered factors including the dose, number of concurrently administered medications, and therapeutic classes of CNS.
Collapse
Affiliation(s)
- Yu-Seon Jung
- Department of Pharmacy, College of Pharmacy, Chung-Ang University, Seoul 06974, Korea; (Y.-S.J.); (H.-D.P.)
| | - David Suh
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Hang-Seok Choi
- Department of Biostatistics, College of Medicine, Korea University, Seoul 02841, Korea;
| | - Hee-Deok Park
- Department of Pharmacy, College of Pharmacy, Chung-Ang University, Seoul 06974, Korea; (Y.-S.J.); (H.-D.P.)
| | - Sun-Young Jung
- Department of Pharmacy, College of Pharmacy, Chung-Ang University, Seoul 06974, Korea; (Y.-S.J.); (H.-D.P.)
- Correspondence: (S.-Y.J.); (D.-C.S.)
| | - Dong-Churl Suh
- Department of Pharmacy, College of Pharmacy, Chung-Ang University, Seoul 06974, Korea; (Y.-S.J.); (H.-D.P.)
- Correspondence: (S.-Y.J.); (D.-C.S.)
| |
Collapse
|