scholarly journals Safe prescribing in cognitively vulnerable patients: the use of the anticholinergic effect on cognition (AEC) tool in older adult mental health services

2019 ◽  
Vol 44 (1) ◽  
pp. 26-30
Author(s):  
Delia Bishara ◽  
Charlotte Scott ◽  
Robert Stewart ◽  
David Taylor ◽  
Daniel Harwood ◽  
...  
Keyword(s):  
Older People ◽  
Older Adult ◽  
Anticholinergic Effect ◽  
Anticholinergic Medication ◽  
Routine Practice ◽  
Accurate Identification ◽  
Adult Services ◽  
Vulnerable Patients ◽  
Burden Scale ◽  
Anticholinergic Burden

Aims and methodMedication with anticholinergic action is associated with potentially serious adverse effects in older people. We present an evaluation of a novel anticholinergic burden scale introduced into routine practice in older adult services in the South London and Maudsley (SLaM) NHS Foundation Trust. Our aim was to assess whether this tool improved the accurate identification of anticholinergic medication and guided safer prescribing in cognitively vulnerable older people.ResultsThe introduction of the anticholinergic effect on cognition (AEC) tool into clinical practice led to an increase in the identification and reporting to general practitioners of anticholinergic medication from 11 to 85% of cases (P = 0.0015).Clinical implicationsApplication of the AEC tool led to improved detection of anticholinergic medication and advice to primary care on when a medication review is necessary. This is an important step towards improving the safety of prescribing in this patient group.

scholarly journals Polypharmacy and potentially inappropriate medications (PIMs) in older adults referred to a memory clinic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S306-S306
Author(s):  
Anietie Akpan ◽  
Bruno De Blaquiere ◽  
Issadevi Nellaya ◽  
Cornelia Termure ◽  
Sujoy Mukherjee
Keyword(s):  
Cognitive Impairment ◽  
Older Adult ◽  
Elderly Care ◽  
Anticholinergic Effect ◽  
Potentially Inappropriate Medications ◽  
List Type ◽  
Number Of Patients ◽  
Burden Scale ◽  
Anticholinergic Burden ◽  
Inappropriate Medications

AimsThe older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and consequently being under the care of several specialists. Adverse drug events and reactions account for significant morbidity and mortality in this population group. Common sequelae include confusional episodes, dementia syndromes, falls, and higher rates of acute hospital admissions.Medications are not routinely reviewed in elderly care. We sought to estimate the prevalence of polypharmacy, and potentially inappropriate medications (e.g. anticholinergics or medications with central anticholinergic effects) in those referred to the Cognitive Impairment and Dementia Service (Elm Lodge), Older Persons Mental Health, West London NHS Trust.MethodAll referrals between 01/10/2020 and 30/11/2020 were screened for medications prescribed. Polypharmacy was defined as prescription of 5 or more medications. Medications with anticholinergic properties were considered examples of Potentially Inappropriate Medications (PIMs). The Anticholinergic Effect on Cognition (AEC) Tool, ‘Medichec’, was used to identify and rate anticholinergic burden. Anticholinergic load was also compared using the Anticholinergic Burden Scale (ABS).ResultTotal number of patients referred – 19311 patients excluded due to unavailable/incomplete medication records.Study number: 182Polypharmacy: 79.67% (n = 145) were prescribed 5 or more medications.44.51% (n = 81) prescribed 5–9 medications.23.08% (n = 42) prescribed 10–14 medications.8.79% (n = 16) prescribed 15–19 medications.1.67% (n = 3) prescribed more than 20 medications.Anticholinergics prescribed (AEC Tool): 37.36% (n = 68) prescribed an anticholinergic.6.59% (n = 12) prescribed more than 1 anticholinergic.Anticholinergics (ABS): 29.67% (n = 54) prescribed an anticholinergic.7.699% (n = 14) prescribed more than 1 anticholinergic.ConclusionPolypharmacy and potentially inappropriate prescribing (e.g. anticholinergics) remain widespread within the older adult population. Anticholinergic load was broadly similar with the Anticholinergic Effect on Cognition tool and the Anticholinergic Burden Scale. Increased anticholinergic burden further compounds risks of cognitive impairment, delirium and death.Other categories of Potentially Inappropriate Medications, including those no longer needed, ought to be identified and reviewed. Over-the-counter medications also need to be screened for.Elimination or reduction of anticholinergic burden may improve quality of life for patients, as well as cost burden on services.Pharmacovigilance, collaborative working, and regular training are needed across services providing care for the older adult.

scholarly journals Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II

2019 ◽  
Author(s):  
Carlota Grossi ◽  
Kathryn Richardson ◽  
George Savva ◽  
Chris Fox ◽  
Antony Arthur ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Older People ◽  
Mini Mental State Examination ◽  
Medication Use ◽  
Anticholinergic Medication ◽  
Older Population ◽  
Clinically Significant ◽  
State Examination ◽  
Anticholinergic Burden

Abstract Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality. The characteristics of the population who use anticholinergic medication are not known. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability. Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects. Key words: cognitive impairment, anticholinergic burden, polypharmacy

scholarly journals Anticholinergic burden measures and older people’s falls risk: a systematic prognostic review

2021 ◽  
Vol 12 ◽  
pp. 204209862110166
Author(s):  
Carrie Stewart ◽  
Martin Taylor-Rowan ◽  
Roy L. Soiza ◽  
Terence J. Quinn ◽  
Yoon K. Loke ◽  
...  
Keyword(s):  
High Risk ◽  
Older People ◽  
Well Being ◽  
Risk Of Bias ◽  
Plain Language ◽  
Risk Of Falling ◽  
Increased Risk ◽  
Burden Scale ◽  
Risk Of Falls ◽  
Anticholinergic Burden

Introduction: Several adverse outcomes have been associated with anticholinergic burden (ACB), and these risks increase with age. Several approaches to measuring this burden are available but, to date, no comparison of their prognostic abilities has been conducted. This PROSPERO-registered systematic review (CRD42019115918) compared the evidence behind ACB measures in relation to their ability to predict risk of falling in older people. Methods: Medline (OVID), EMBASE (OVID), CINAHL (EMBSCO) and PsycINFO (OVID) were searched using comprehensive search terms and a validated search filter for prognostic studies. Inclusion criteria included: participants aged 65 years and older, use of one or more ACB measure(s) as a prognostic factor, cohort or case-control in design, and reporting falls as an outcome. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results: Eight studies reporting temporal associations between ACB and falls were included. All studies were rated high risk of bias in ⩾1 QUIPS tool categories, with five rated high risk ⩾3 categories. All studies (274,647 participants) showed some degree of association between anticholinergic score and increased risk of falls. Findings were most significant with moderate to high levels of ACB. Most studies (6/8) utilised the anticholinergic cognitive burden scale. No studies directly compared two or more ACB measures and there was variation in how falls were measured for analysis. Conclusion: The evidence supports an association between moderate to high ACB and risk of falling in older people, but no conclusion can be made regarding which ACB scale offers best prognostic value in older people. Plain language summary A review of published studies to explore which anticholinergic burden scale is best at predicting the risk of falls in older people Introduction: One third of older people will experience a fall. Falls have many consequences including fractures, a loss of independence and being unable to enjoy life. Many things can increase the chances of having a fall. This includes some medications. One type of medication, known as anticholinergic medication, may increase the risk of falls. These medications are used to treat common health issues including depression and bladder problems. Anticholinergic burden is the term used to describe the total effects from taking these medications. Some people may use more than one of these medications. This would increase their anticholinergic burden. It is possible that reducing the use of these medications could reduce the risk of falls. We need to carry out studies to see if this is possible. To do this, we need to be able to measure anticholinergic burden. There are several scales available, but we do not know which is best. Methods: We wanted to answer: ‘Which anticholinergic scale is best at predicting the risk of falling in older people?’. We reviewed studies that could answer this. We did this in a systematic way to capture all published studies. We restricted the search in several ways. We only included studies relevant to our question. Results: We found eight studies. We learned that people who are moderate to high users of these medications (often people who will use more than one of these medications) had a higher risk of falling. It was less clear if people who have a lower burden (often people who only use one of these medications) had an increased risk of falling. The low number of studies prevented us from determining if one scale was better than another. Conclusion: These findings suggest that we should reduce use of these medications. This could reduce the number falls and improve the well-being of older people.

scholarly journals 144 Polypharmacy and Anticholinergic Burden in Older People in Brunei Darussalam

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv34-iv39
Author(s):  
Su Ying Yeo ◽  
Sanny Zi Lung Choo ◽  
Nadzirah Rosli ◽  
Eng Chong Koh ◽  
Shyh Poh Teo
Keyword(s):  
Older People ◽  
High Rate ◽  
Electronic Prescribing ◽  
Healthcare Sector ◽  
National Study ◽  
Public Healthcare ◽  
Anticholinergic Medication ◽  
Brunei Darussalam ◽  
Recurrent Falls ◽  
Anticholinergic Burden

Abstract Introduction Polypharmacy and anticholinergic burden are associated with falls in older people. A longitudinal study found patients with five or more drugs had 21% increased falls over 2 years. [Dhalwani, Fahami, Sathanapally et al, BMJ Open, 2017,7(10), e016358]. A cohort study identified a 1.51 odds of recurrent falls with anticholinergic medication, while taking multiple anticholinergics resulted in 100% likelihood of recurrent falls. [Marcum, Wirtz, Pettinger, et al, BMC Geriatrics, 2016,16,76]. Methods Retrospective study of polypharmacy in older people in Brunei based on data from Bru-HIMS, the Brunei public healthcare sector electronic prescribing and pharmacy management system. In this national study, stratified sampling was done by district, with patients randomly selected within each district. Active medications were identified from Bru-HIMS. The Anticholinergic Cognitive Burden (ACB) Scale was used to calculate anticholinergic burden. Findings for two districts (Tutong and Temburong) are described. Results For the 327 patients, 142 (43%) were male and 185 (57%) female. Median age was 72 years (Range 65 to 103 years). 234 (72%) had 5 drugs or more prescribed. Of the 2332 prescriptions, 268 (11.5%) had anticholinergic activity on the ACB scale. Median ACB score was 1. The most commonly prescribed were Orphenadrine, Chlorpheniramine, Diphenhydramine, Cinnarizine and Amitriptyline. There was a positive correlation between polypharmacy and anticholinergic burden (r = 0.4593). Conclusion There was a high rate of polypharmacy in older people, with anticholinergic drug burden identified. It may be useful to educate clinicians and patients regarding risks of polypharmacy and anticholinergic burden, including falls.

Anticholinergic burden in older inpatients on psychotropic medication: do we care?

2017 ◽  
Vol 25 (6) ◽  
pp. 566-570 ◽  
Author(s):  
Mei Shiang Lee ◽  
Steve Kisely ◽  
Boris Zolotarev ◽  
Andrew Warren ◽  
Jack Henderson ◽  
...  
Keyword(s):  
Scale Score ◽  
The Elderly ◽  
Prescribing Patterns ◽  
Anticholinergic Medication ◽  
Therapeutic Effects ◽  
Scale Scores ◽  
Burden Scale ◽  
Older Inpatients ◽  
Discharged Patients ◽  
Anticholinergic Burden

Objectives: This quality activity explored the prescribing patterns in an Older Persons Mental Health Inpatient Unit in order to establish whether the Anticholinergic Cognitive Burden Scale (ACB Scale) score on admission was reviewed to minimise anticholinergic cognitive burden (ACB) while maintaining therapeutic effects. Methods: A retrospective electronic chart review of 50 discharged patients for any documented ACB review by the treating team, as well as the ACB Scale scores on admission and discharge. Findings: ACB was rarely considered. On average, the total ACB Scale scores on admission and discharge were high. At the time of discharge, the proportion of patients on at least one anticholinergic medication had significantly increased, and only 10% of patients were on no anticholinergic medication. Approximately 50% of patients had an increased ACB Scale score by discharge as opposed to only 8% who had reduced scores. Conclusions: Anticholinergic polypharmacy should be minimised when prescribing to the elderly population to reduce potential anticholinergic burden.

A Ministry of Memory: Spiritual Care for the Older Adult With Dementia

2004 ◽  
Vol 5 (3) ◽  
pp. 183-187 ◽  
Author(s):  
Sharon Fish Mooney
Keyword(s):  
Older People ◽  
Older Adult ◽  
Spiritual Care ◽  
Cognitive Abilities ◽  
Elderly Persons ◽  
People With Dementia ◽  
Worship Services ◽  
Christian Worldview ◽  
Primary Focus ◽  
Progressive Cognitive Impairment

The primary focus of research related to spiritual and ministry needs of older people, historically and in the present, has been on those whose cognitive abilities are only minimally impaired. The older adult with a dementia like Alzheimer’s disease, however, has not received as much attention. This may be related to a lack of any theoretical framework from which to understand what may be happening to a markedly confused person spiritually, and how a person with progressive cognitive impairment might still be able to maintain a relationship with God and be ministered to by a God who may only be remembered vaguely, if at all. Elderly persons with dementia with a faith background rooted in the Judeo-Christian worldview are often able to respond to various rituals of their faith, verbally, physically, and emotionally. Common practices like familiar prayers, Bible readings, hymns, and attendance at worship services where collective memory is shared can serve as memory joggers to reconnect the person, not only to the faith community, but to a faithful God. A spiritual care ministry to older people with dementia can be considered a ministry of memory.

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