Polypharmacy and associated cumulative anticholinergic burden are important predictors of falls risk DOI Open Access
Ho Lun Wong, Amit K. J. Mandal,

Claire Weaver

et al.

British Journal of Clinical Pharmacology, Journal Year: 2023, Volume and Issue: 89(7), P. 2332 - 2333

Published: May 3, 2023

It is evident that polypharmacy among older adults results in increased cumulative anticholinergic exposure and several adverse outcomes. We read with interest congratulate Hilmer et al. on their multicentre cohort study Australia, investigating the association between sedative medication The authors conclude potentially inappropriate medications (PIMS) drug burden index (DBI) are significantly associated risks of fall delirium.1 would like to share our experience from United Kingdom where a known growing phenomenon effects adults.2 investigated potential confounding (ACB) hospitalized fall. prospectively evaluated 411 consecutive patients aged ≥65 years (mean age 83.8 ± 8.0 years: 40.6% male) admitted acutely hospital. Pharmacological reconciliation was carried out by hospital pharmacists utilizing national patient database: NHS Summary Care Record, which contains all regular acute prescriptions. Incidence (defined as prescription ≥5 oral medications), ACB score (http://www.acbcalc.com/) Charlson Comorbidity Index (CCI) were recorded compared or without further polypharmacy, summative score, CCI, falls risk. Overall incidence group 80.8%, consistent previous epidemiology studies.3 Polypharmacy 76.3% 88.0%, respectively. 0, 1, 2 ≥3 38.7%, 20.9%, 14.6% 25.8%, On multivariate analysis, (OR = 1.030, [1.000; 1.050], P 0.049), 1.150, [1.020; 1.290], 0.025), 2.140, [1.190; 3.870], 0.012) but not CCI 0.920, [0.810; 1.040], 0.172) higher rate (Table 1). linear regression an 3 0 have >50% chance falling. also found fall, 29.8% had drug-related orthostatic hypotension, 24.7% bradycardia, 37.3% prescribed centrally acting drugs 12.0% taking hypoglycaemic agents. Our complements findings other recent studies suggesting risk adults.2, 4, 5 data demonstrated presence each unit rise stronger effect increasing comorbidities. modifiable factors, strongly support deprescribing when possible prevent improve outcomes adults.6, 7 Further required clinical benefits its feasibility setting. None.

Language: Английский

Polypharmacy and cumulative anticholinergic burden in older adults hospitalized with fall DOI Creative Commons
Ho Lun Wong,

Claire Weaver,

Lauren Marsh

et al.

Aging Medicine, Journal Year: 2023, Volume and Issue: 6(2), P. 116 - 123

Published: April 5, 2023

Polypharmacy is a growing phenomenon associated with adverse effects in older adults. We assessed the potential confounding of cumulative anticholinergic burden (ACB) patients who were hospitalized falls.

Language: Английский

Citations

15
Polypharmacy and anticholinergic burden scales in older adults: a cross-sectional study among psychiatric outpatients in a tertiary care hospital DOI Creative Commons
Manjunath Bidarolli, Biswadeep Das, Vikram Singh Rawat

et al.

BMC Geriatrics, Journal Year: 2025, Volume and Issue: 25(1)

Published: Jan. 20, 2025

Mental disorders are prevalent among older adults, often leading to the use of multiple medications, many with anticholinergic properties. Polypharmacy, common in this population, is a major contributor burden, which linked cognitive and physical decline. This study investigates relationship between polypharmacy burden across seven scales elderly patients attending psychiatric outpatient. Study was conducted at psychiatry outpatient clinic All India Institute Medical Sciences, Rishikesh, India, from December 2021 March 2023. Elderly (aged ≥ 60 years) who were on least one psychotropic medication had primary working diagnosis illness included. including antidepressants, antipsychotics, mood stabilizers, hypnotics, evaluated. Anticholinergic calculated by respective tools. Univariate analysis adopted determine factors that may affect polypharmacy. included 1165 aged years. The prevalence 20.43% (n = 238). Clonazepam 364, 17.28%), escitalopram 197, 9.35%), metformin 165, 7.83%), sertraline 141, 6.69%), mirtazapine 129, 6.12%), lorazepam 110, 5.22%) most frequently prescribed drugs. demonstrated all risk assessment closely correlated polypharmacy, strongest association observed for Load Scale (ALS) (Odds Ratio 4.3; p < 0.001). Polypharmacy also positively associated adverse drug reactions 1.81; 95% Confidence Interval 1.27–2.56). cohort high, 95.1% 1108) experiencing significant burden. Adverse events stronger correlation ALS scores than other adults.

Language: Английский

Citations

0
Anticholinergic drug exposure is associated with prevalence, worsening and incidence of dysphagia among hospitalized older adults DOI Creative Commons
Lucia Muglia, Alessia Beccacece, Luca Soraci

et al.

The journal of nutrition health & aging, Journal Year: 2025, Volume and Issue: 29(5), P. 100507 - 100507

Published: Feb. 13, 2025

Language: Английский

Citations

0
Multimorbidity, medications, and their association with falls, physical activity, and cognitive functions in older adults: multicenter study in Sri Lanka DOI Creative Commons
Warsha De Zoysa,

Sahan Benedict Mendis,

Nirmala Rathnayake

et al.

Scientific Reports, Journal Year: 2025, Volume and Issue: 15(1)

Published: Feb. 20, 2025

This study was aimed to examine the prevalence and associations between multimorbidity, polypharmacy, Falls Risk Increasing Drugs use (FRIDs), Anti Cholinergic Burden (ACB), adverse health outcomes in older adults attending medical clinics. A cross-sectional conducted among 704 clinics four tertiary care hospitals. The mean (SD) age of participants 73 (5.5) years, majority were females (58.7%). Patients 305 (43.5%) reported at least one fall after 65 while 220 (31.3%) falls previous 12 months 90 (12.8%) recurrent falls. multimorbidity 77.4% polypharmacy seen 51.2%. FRID 70.5% patients higher ACB 5.4%. Multimorbidity, FRIDs not associated with negative outcome (p > 0.05). Polypharmacy, however, high < 0.001). highlights a people clinical settings. However, drugs indicate that these relationships are complex, potentially influenced by other factors such as poor drug compliance, which can lead

Language: Английский

Citations

0
Disentangling drug contributions: anticholinergic burden in older adults linked to individual medications: a cross-sectional population-based study DOI Creative Commons

Gauri Bhatkhande,

Niteesh K. Choudhry, Mufaddal Mahesri

et al.

BMC Geriatrics, Journal Year: 2024, Volume and Issue: 24(1)

Published: Jan. 10, 2024

Abstract Background Medications with potent anticholinergic properties have well-documented adverse effects. A high cumulative burden may arise from the concurrent use of multiple medications weaker We sought to identify patterns and associated patient characteristics. Methods identified patients aged ≥ 65 who filled 1 medication effects in 2019 had a Anticholinergic Burden score (ACB) 4 (i.e., burden) large US health insurer. classified based on how they attained burden, as follows: 1) only filling strong or moderate ACB = 2 3, “moderate/strong”), 2) lightly 1, “light/possible”), 3) any combination (“mix”). used multinomial logistic regression assess association between measured characteristics membership three classifications, using moderate/strong group referent. Results In total, 83,286 eligible were (mean age: 74.3 years (SD:7.1), 72.9% female). Of these, 4.5% strong/moderate anticholinergics, 4.3% light/possible rest mix (91.2%). Within mixed group, 64.3% fills for while 35.7% anticholinergics. Compared anticholinergics more likely be older (adjusted Odds Ratio [aOR] per 1-unit 1.06, 95%CI: 1.05–1.07), less female (aOR: 0.56, 0.50–0.62 vs. male), comorbidities (e.g., heart failure aOR: 3.18, 2.70–3.74 depression 1.20, 1.09–1.33 no comorbidity), visited fewer physicians (aOR change: 0.98, 0.97–0.98). Patients 1.02, 1.02–1.03) 0.89, 0.82–0.97 male) compared those Conclusion Most adults accumulated through rather than being major drivers overall burden. These insights inform interventions improve prescribing adults.

Language: Английский

Citations

2
Assessment of potentially inappropriate medications among long-stay older adult patients with serious mental illnesses: findings from a low-resource setting DOI Creative Commons

Ghinwa Abilmona,

Feten Fekih‐Romdhane, Souheil Hallit

et al.

Middle East Current Psychiatry, Journal Year: 2024, Volume and Issue: 31(1)

Published: April 29, 2024

Abstract Background Potentially inappropriate medications (PIMs) are defined as drugs whose adverse effects outweigh the benefits or when more efficacious alternatives present. This study aims to assess overall prevalence of PIMs according Beers 2019 and 2023 among older adult patients with serious mental illnesses (such schizophrenia), factors associated while examining difference between two versions. Method cross-sectional included chronic aged 65 years above, hospitalized at Psychiatric Hospital Cross (Lebanon), taking least one medication daily. Sociodemographic characteristics, medications, clinical information were obtained from patients’ medical records. SPSS version 26 was used for data analysis. Descriptive statistics describe independent variables, bivariate analysis associations PIM use different factors. A two-tailed p value < 0.05 considered statistically significant. Results Ninety-seven a mean age 71.21 (± 4.63) years. 52.6% female. 44.3% on polypharmacy (5–9 medications). 97.9% had both versions majority being anticholinergics (84.5%). Polypharmacy significantly correlated use. stay length presence comorbid neurological disorders negatively Conclusion extremely prevalent psychiatric patients. Raising awareness physicians criteria making them mandatory could help diminish this vulnerable population.

Language: Английский

Citations

2
Examining potentially inappropriate medication use among elderly individuals in palliative care: A comprehensive study DOI Creative Commons

Ozlem Kirci,

Mahcube Çubukçu,

Remzi Bahsi

et al.

Heliyon, Journal Year: 2024, Volume and Issue: 10(10), P. e30635 - e30635

Published: May 1, 2024

This study aimed to evaluate the prevalence of polypharmacy, presence potentially inappropriate medications and related factors in older adults receiving palliative care. cross-sectional descriptive was performed 213 patients who were served from care services. Mini Nutritional Assessment-Short Form, Katz Activities Daily Living Scale Charlson Comorbidity Index applied. Polypharmacy defined as use 5 or more medicines while 10 considered hyper-polypharmacy. PIM assessed according TIME-to START STOP criteria. A total included, mean age 78.00 ± 9.08 years. present 59.2 % hyper-polypharmacy 10.8 %. There a statistically significant correlation between polypharmacy marital status, history falls, mid-upper arm, calf circumference (p = 0.017, p 0.022, 0.010, 0.003, respectively). The rate medication cardiovascular system, gastrointestinal analgesics, musculoskeletal nervous system drugs high. at least one 56.3 adults. PIMs 18.3 TIME-to-START criteria 48.4 TIME-to-STOP higher TIME group with than non-polypharmacy < 0.001). is high could increase use. may be helpful reducing

Language: Английский

Citations

2
Anticholinergic action is rarely a good thing DOI Creative Commons
Delia Bishara

Therapeutic Advances in Psychopharmacology, Journal Year: 2023, Volume and Issue: 13

Published: Jan. 1, 2023

The evidence for the risks associated with anticholinergic agents has grown considerably in last two decades. Not only are they causing peripheral side effects such as dry mouth, blurred vision and constipation, but can also cause central cognitive impairment; more recently, have consistently been linked an increased risk of dementia death older people. This paper reviews associations mortality dementia.

Language: Английский

Citations

3
Increased anticholinergic medication use in middle‐aged and older autistic adults and its associations with self‐reported memory difficulties and cognitive decline DOI Creative Commons
Goldie A. McQuaid, Sean C. Duane,

Neha Ahmed

et al.

Autism Research, Journal Year: 2023, Volume and Issue: 17(4), P. 852 - 867

Published: Dec. 18, 2023

Many commonly used prescription and over-the-counter medicines have potent anticholinergic (AC) effects. Among older adults, AC medications are associated with cognitive impairment risk for disorders, including Alzheimer's disease. Collectively, the impact of is known as burden (ACB). Because high rates co-occurring medical psychiatric conditions, autistic adults may exposure and, thus, experience elevated ACB. However, no research has characterized or examined its associations outcomes in adults. Autistic (40-83 years) recruited via Simons Powering Autism Research's (SPARK) Research Match service self-reported their medication use (N = 415) memory complaints 382) at Time (T)1. At T2, 2 years later, a subset T1 participants 197) on decline cognition. Medications were coded using two scales potency. A proportion (48.2%-62.9%, depending upon potency scale) reported taking least one effects, 20.5% to 26.5% clinically-relevant levels (potency ≥3). After controlling birth-sex, age, hierarchical linear regression models showed total ACB scores values ≥3 predicted greater complaints. Logistic that follow-up later. Understanding medications-including potentially earlier polypharmacy-and impacts cognition (e.g., dementia risk) warranted.

Language: Английский

Citations

3
Polypharmacy, anticholinergic burden and drug–drug interaction assessment in people with four-class-resistant HIV: data from the PRESTIGIO registry DOI
Maria Mazzitelli, Domenico Pontillo, Tommaso Clemente

et al.

Journal of Antimicrobial Chemotherapy, Journal Year: 2024, Volume and Issue: 79(9), P. 2163 - 2169

Published: July 13, 2024

To evaluate polypharmacy, anticholinergic burden (ACB) and drug-drug interactions (DDIs) in people with four-class-resistant HIV (4DR-PWH).

Language: Английский

Citations

0