Evaluation of anticholinergic burden of medications in older adults

Abstract

Objectives: To calculate and describe the anticholinergic burden of medications in community-dwelling older adults and to identify patient-specific risk factors. Design: Descriptive cross-sectional study. Setting: Cardinal Health Visiting Pharmacist Program, Columbus, OH, between August 2002 and August 2009. Participants: Community-dwelling adults 65 years or older who were referred through LifeCare Alliance (a provider of home-based senior services). Intervention: Comprehensive medication review records from medication therapy management (MTM) activities were used to calculate the anticholinergic burden using the anticholinergic cognitive burden (ACB) scale for each patient. Main outcome measure: Proportion of older adults in the community with a clinically relevant anticholinergic burden (defined as ACB score e3). Results: From 341 included records, ACB score was calculated for all patients and an ACB score of 3 or greater was identified in 47.8% (n = 163) of patients. The odds increased significantly as the number of prescription (odds ratio 1.23 [95% CI 1.14-1.32], P < 0.001] and over-the-counter (1.17 [1.02-1.33], P = 0.02] medications increased. The odds also were significantly greater for patients with hypertension (3.01 [1.73-5.21], P < 0.001) and depression (2.6 [1.14-5.9], P = 0.02). Conclusion: Nearly one-half of community-dwelling older adults had a clinically relevant ACB score of 3 or greater. The ACB score could be used as a component of MTM services in a variety of practice settings to identify older adults who are at higher risk for potential central and peripheral adverse effects related to cumulative anticholinergic activity of their medications. Additional research to measure the clinical impact of ACB assessment and modification is needed.