Background Medicines with anticholinergic activity have been linked to a variety of adverse drug reactions in the elderly.
Purpose To determine the anticholinergic burden in revised profiles, and the level of risk.
Materials and Methods The Prescription Quality Unit (PQU), which is staffed by a doctor, two pharmacists, a nurse and other technical-administrative staff, is integrated into the geriatric care team. The Unit provides care to 6800 residents in 163 centres.
The PQU provides training and support to different care teams by reviewing procedures and holding conciliation meetings. The process of rationalisation consists of systematically reviewing medicines plans according to the criteria of efficacy, safety and efficiency. The team suggests modifications in medicines plans and reports to the health care professionals involved. Anticholinergic drugs were selected from the review. These medicines were classified into four groups, according to the anticholinergic potency.
Results A prospective study was undertaken during the period June 2011–June 2012: 7,347 patients were reviewed (some in duplicate). 959 patients were identified, and those patients were prescribed 1,984 drugs with anticholinergic activity (mean age 85 years (52–111 years)).
In 162 patients, strong anticholinergic activity drugs were found: 62% oral antimuscarinics for urinary incontinence, 33% tricyclic antidepressants, 4% antispasmodics with anticholinergic properties and 1% systemic H1 antihistamines (dexchlorpheniramine); 252 patients with moderate anticholinergic activity drugs (70% paroxetine); 500 patients with mild anticholinergic drugs and 45 patients had drugs whose activity was concentration-dependent.
Sixty-eight patients were simultaneously being prescribed more than one medicine with anticholinergic activity (17 patients on strong anticholinergic activity drugs simultaneously).
Conclusions Due to the comorbidities and frailty of this population, medicines must be selected individually for each patient, selecting drugs with the lowest level of anticholinergic activity. We observed a group of patients at special risk who were being treated for pathologies related to the urinary tract.
No conflict of interest.
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