Use of Anticholinergics in the Nursing Home: An Empirical Study and Review

The Medicare Utilization Review Committee conducted a survey to determine the use of drugs with anticholinergic effects in confused elderly nursing home patients. Twenty-nine patients (34.5 percent) were receiving anticholinergic drugs, predominantly from the antidepressant and antipsychotic class. Thioridazine (Mellaril) was the most frequently used antipsychotic. No patients received higher than the equivalent recommended daily dose of atropine when calculated in terms of relative anticholinergic potency. No statistically significant correlation could be found between the presence of confusion and the amount of anticholinergics administered. Confusion and cognitive deterioration frequently are encountered when caring for aged patients. Clinical experience and recent studies suggest that anticholinergics may increase the risk of or exacerbate existing confusion, and this possible effect of anticholinergic activity should be considered when prescribing for elderly patients.

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CUMULATIVE CHOLINOLYTIC EFFECT IN CLINICAL PRACTICE (LITERATURE REVIEW)

Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії ◽

10.31718/2077-1096.21.1.188 ◽

2021 ◽

Vol 21 (1) ◽

pp. 188-193

Author(s):

R.B. Savchenko

Keyword(s):

Clinical Practice ◽

Absolute Risk ◽

Anticholinergic Effect ◽

Medical Community ◽

Anticholinergic Drugs ◽

Anticholinergic Agents ◽

Review Of The Literature ◽

Aged Patients ◽

Anticholinergic Activity ◽

Analytical Review

Anticholinergic agents are widely used in clinical practice. However, they can cause various cumulative side effects (dry mouth, drowsiness, confusion, residual urine accumulation, etc.). The purpose of the study is to perform an analytical review of the literature dedicated to causes, complications and rehabilitation of patients with cumulative anticholinergic effect. The analytical review of the literature highlights the risks and benefits of using anticholinergic drugs. Anticholinergic agents make up to one third of all medicines for the aged people. Recent data have proved the relationship between the long-term use of anticholinergics and dementia. New results relating to the cholinergic system in the regulation of cerebral vascularisation and in neuritis indicate that anticholinergics may contribute to the absolute risk and progression of neurodegenerative diseases. It has been proven that more than 600 drugs taken by aged patients carry the so-called "anticholinergic load". The number of drugs with anticholinergic properties is constantly increasing, they include: antidepressants, antihistamines, antiparkinsonian, antipsychotic, antispasmodic, mydriatic drugs, drugs for the treatment of overactive bladder and many others. Conclusions. The number of drugs that have anticholinergic activity and can cause complications associated with anticholinergic load is increasing. To assess the anticholinergic action of drugs, several methods have been proposed, taking into account the amount of dose and the intensity of anticholinergic activity of drugs. The research of the general medical community about the anticholinergic load problem and high alertness when prescribing drugs with anticholinergic properties can prevent the cumulative anticholinergic effect development and severe complications, and, thus, save the life and health of patients.

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Vitamin D Supplementation in Nursing Home Patients: Randomized Controlled Trial of Standard Daily Dose Versus Individualized Loading Dose Regimen

Drugs & Aging ◽

10.1007/s40266-015-0259-8 ◽

2015 ◽

Vol 32 (5) ◽

pp. 371-378 ◽

Cited By ~ 9

Author(s):

Hugo Wijnen ◽

Dayenne Salemink ◽

Lian Roovers ◽

Diana Taekema ◽

Hans de Boer

Keyword(s):

Vitamin D ◽

Randomized Controlled Trial ◽

Nursing Home ◽

Dose Regimen ◽

Controlled Trial ◽

Vitamin D Supplementation ◽

Loading Dose ◽

Randomized Controlled ◽

Nursing Home Patients ◽

Daily Dose

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Evaluation of prescribing quality in nursing homes based on drug-specific indicators: The Bergen district nursing home (BEDNURS) study

Norsk Epidemiologi ◽

10.5324/nje.v18i2.31 ◽

2009 ◽

Vol 18 (2) ◽

Cited By ~ 1

Author(s):

Sabine Ruths

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Cross Sectional Study ◽

Anticholinergic Drugs ◽

Cross Sectional ◽

National Board ◽

Prescribing Quality ◽

Nursing Home Patients ◽

Potentially Inappropriate Prescription ◽

Long Acting

To examine prescribing quality among nursing home patients. Methods: A cross sectional study in 23 nursing homes, based on drug charts. The evaluation of prescribing quality was based on selected drug-specific indicators established by the Swedish National Board of Health and Welfare. Logistic regression analysis was used to examine associations between prescribing indicators and predictors related to patient (age, gender, drug number) and institution (nurse and physician staff time) characteristics. Results: A total of 1513 nursing home patients (76% women, mean age 85 years) were included in the study. On average, the patients used 5.1 (SD 2.5) standing medications. Laxatives were most commonly used (58%), followed by loop-diuretics (35%), antidepressants (31%), and anti-thrombotic agents (27%). Altogether 850 (56%) patients used at least one potentially inappropriate prescription (PIP), including long-term use of contact laxatives without proper indication (25%), long-acting benzodiazepines (17%), and anticholinergic drugs (16%). The number of drugs used was the most important determinant for any PIP as well as for all individual indicators (p<0.001). Relatively younger patients were more likely to receive any PIP, and in particular anticholinergic drugs, multiple psychotropic drugs, and interacting drugs (p<0.05). Conclusion: Prescribing quality assessment by use of drug-specific indicators revealed great potentials for improving drug therapy in Norwegian nursing homes.

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