Background Drugs with anticholinergic and sedative effects carry significant risks in older people. An increased incidence of falls, impaired physical function and cognitive decline has been attributed to the use of these drugs.
Purpose To estimate the Risk of Anticholinergic Effects (RAE) in patients with several conditions based on their pharmacotherapy.
Material and methods Cross-sectional study of RAE in a cohort of patients included in the IMPACT project (October 2010–April 2012).
Anticholinergic exposure was calculated using the Anticholinergic Risk Scale (ARS) and Anticholinergic Cognitive Burden (ACB). These are reliable lists of drugs with a measure for the anticholinergic load. Higher scores are associated with increased RAE.
The age, sex and pharmacotherapy were collected for each patient. The RAE measured was defined as patients treated with at least one anticholinergic drug according to the ARS and ACB scales.
Results Eighty patients were analysed. The mean age was 78.2 ± 8.2 years, 55.0% were men and the mean number of medicines was 12.9 ± 3.5.
The ACB identified 68 patients (85% of individuals) as exposed to a medicine with anticholinergic potency: 47 patients (58.7%) with ACB level of 1, 13 (16.2%) with level 2 and 8 (10.0%) with level ≥3.
The ARS identified 15 patients (18.7%): 11/15 patients with ARS level of 1 and 4/15 with level 2.
The most common medicines was furosemide (77.5%) with ACB level of 1, digoxin (6.25%) with ACB level of 1, metoclopramide (5%) with ARS level of 1, risperidone (5%) with a level of 1 on both scales, atenolol (3.75%) with ACB level of 1 and paroxetine (3.75%) with ACB level of 3 ACB and ARS level of 1.
Conclusion A high proportion of polymedicated patients are at risk of anticholinergic adverse events due to treatment. Detection of patients with RAE can be an important strategy for optimising drug treatment in these patients.
Kersten H, Wyller TB. Anticholinergic Drug Burden in Older People’s Brain – How well is it Measured? Basic Clin Pharmacol Toxicol 2014;114(2):151–221. doi: 10.1111/bcpt.12140
ReferenceNo conflict of interest.
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