Anticholinergic drugs and health-related quality of life in older adults with dementia

This study was done to see if anticholinergic drugs could be leading to a decreased quality of life among older adults with dementia. There were 112 people involved in the study, most of whom were between the ages of 65 and 79 years old. The results were measured using two separate scores. There was a Physical Component score and a Mental Component score. The results showed a significant decrease in the physical component score, equating to a decreased quality of life. There was no association found between anticholinergic drug use and the mental component score.

Anticholinergic drugs are used to treat a wide variety of medical conditions, many of which are common in older adults, but there are adverse effects with these drugs that could potentially be very dangerous. Anticholinergic drugs can effect mental concentration and increase the risk of falls in older adults. They also cause other adverse effects, such as constipation, urinary retention, and xerostomia, which can lead to a decrease in the patient’s quality of life. Since the drugs were only shown to decrease patient’s physical quality of life and did not improve their mental component score, anticholinergic drugs may not be the best way to treat older patients with dementia.

 

Sneha D. Sura, Ryan M. Carnahan, Hua Chen, Rajender R. Aparasu. Anticholinergic drugs and health-related quality of life in older adults with dementia. Journal of American Pharmacists Association.  2015;55;282-287

http://www.japha.org/article/S1544-3191(15)30061-3/fulltext

Potentially inappropriate anticholinergic medication use in older adults with dementia

This was a cross-sectional study done to assess the prevalence of inappropriate anticholinergic medication use in elder dementia patients.  The study used the American Geriatrics Society Beers criteria as guidelines for what medications were considered as potentially inappropriate to use.  This study was published in 2015, however, the data used was from a 2009-2010 national representative health care utilization survey called MEPS.  The MEPS data showed that about 3.78 million adults 65 years old and older were diagnosed with dementia.  Out of those diagnosed with dementia, 1.02 million adults (26.95%) were on potentially inappropriate anticholinergic medications.  The analysis was then further broken down to examine the percentage of patients with dementia over 65 years old who were also diagnosed with either mood disorders (17%) or anxiety (15%).  The conclusion drawn included that those with mood disorders or anxiety had an increased chance of inappropriate anticholinergic medication use, while those 75 to 84 years old had a decreased risk.

The most frequently found medication that could possibly cause inappropriate anticholinergic medication use, according to American Geriatrics Society Beers criteria, was oxybutynin.  Oxybutynin had been found to be the inappropriate medication 16.8% of the time, while solifenacin closely followed at 16.6%.  Some of the other medications often found were paroxetine, tolterodine, promethazine, and cyclobenzaprine.  The geriatric population with dementia already has an increased sensitivity to anticholinergic activity, and therefore this article recommends that anticholinergic medications should be minimized or avoided completely if possible.

Overall, this is an important article because we, as future pharmacists, have to be aware, and stay alert for recommendations such as the avoidance/minimization of the use of anticholinergic medications in dementia patients.  With the geriatric population on the rise, how could studies like this impact pharmacy medication interaction screenings?

J Am Pharm Assoc. 2015;55(6):603-612.