Potentially inappropriate anticholinergic medication use in older adults with dementia

Nandita Kachru; Ryan M Carnahan; Michael L Johnson; Rajender R Aparasu

doi:10.1331/JAPhA.2015.14288

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Potentially inappropriate anticholinergic medication use in older adults with dementia

Journal article

Peer reviewed

Potentially inappropriate anticholinergic medication use in older adults with dementia

Nandita Kachru, Ryan M Carnahan, Michael L Johnson and Rajender R Aparasu

Journal of the American Pharmacists Association, Vol.55(6), pp.603-612

11/2015

DOI: 10.1331/JAPhA.2015.14288

PMID: 26501745

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Abstract

To examine the prevalence and predictors of potentially inappropriate anticholinergic medication use in older adults with dementia. A cross-sectional study. United States, 2009-2010. Medical Expenditure Panel Survey household component participants aged 65 years or older identified as having dementia and using potentially inappropriate anticholinergic medication. Prevalence and predictors of potentially inappropriate anticholinergic medication use as per the updated 2012 American Geriatrics Society Beers criteria. A total of 3.78 million older adult patients (95% confidence interval [CI] 3.17 million to 4.38 million) were identified as having dementia, for an overall prevalence of 4.81%. Of those patients, an estimated 1.02 million (95% CI 0.70 million to 1.30 million) were reported to use potentially inappropriate anticholinergic medications, for an overall prevalence of 26.95% (95% CI 20.10% to 33.79%). The most frequently prescribed drugs were oxybutynin, solifenacin, paroxetine, tolterodine, promethazine, and cyclobenzaprine. Multivariable logistic analysis revealed that those patients with the need characteristics of self-reported anxiety, mood disorders, and "fair/poor" general health status had increased odds of potentially inappropriate anticholinergic use, while patients with the predisposing characteristic of being aged 75-84 years had decreased odds of potentially inappropriate anticholinergic use. More than one in four older adults with dementia were found to use potentially inappropriate anticholinergics. Given the adverse cognitive effects of these medications, there is a strong need to monitor and optimize their use in older adult patients with dementia.

Multivariate Analysis

United States - epidemiology

Prevalence

Age Factors

Cross-Sectional Studies

Dementia - psychology

Inappropriate Prescribing

Humans

Risk Factors

Medication Errors - prevention & control

Dementia - diagnosis

Logistic Models

Male

Dementia - epidemiology

Cognition - drug effects

Drug Utilization Review

Polypharmacy

Aged, 80 and over

Female

Aged

Odds Ratio

Cholinergic Antagonists - adverse effects

Cholinergic Antagonists - therapeutic use

Details

Title: Subtitle: Potentially inappropriate anticholinergic medication use in older adults with dementia
Creators: Nandita Kachru - Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX
Ryan M Carnahan - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
Michael L Johnson - Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX
Rajender R Aparasu - Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX. Electronic address: rraparasu@uh.edu
Resource Type: Journal article
Publication Details: Journal of the American Pharmacists Association, Vol.55(6), pp.603-612
DOI: 10.1331/JAPhA.2015.14288
PMID: 26501745
NLM abbreviation: J Am Pharm Assoc (2003)
ISSN: 1544-3450
eISSN: 1544-3450
Publisher: United States
Language: English
Date published: 11/2015
Academic Unit: Epidemiology; Injury Prevention Research Center
Record Identifier: 9983995125102771

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