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Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia.
Am J Geriatr Pharmacother. 2011 Dec; 9(6):434-41.AJ

Abstract

BACKGROUND

Anticholinergic medications, although frequently used in elderly populations, are associated with cognitive impairment and constitute significant concern for patients with dementia.

OBJECTIVE

The purpose of our study was to examine patterns and predictors of prescribing anticholinergic agents for elderly outpatients with dementia.

METHODS

We combined data from the 2006-2007 National Ambulatory Medical Care Survey and the outpatient department component of National Hospital Ambulatory Medical Care Survey to analyze patient visits by elderly persons (aged ≥65 years) with dementia. Anticholinergic drugs were identified using the Anticholinergic Drug Scale, which classifies anticholinergic drugs into four levels (0-3) in increasing order of anticholinergic activity. Descriptive analysis using sampling weights was used to evaluate patterns of anticholinergic drug prescription, especially prescribing of medications with clinically significant anticholinergic activity (ie, levels 2 or 3). Multiple logistic regression was used in the conceptual framework of the Andersen Behavioral Model to examine the predisposing, enabling, and need factors associated with prescribing of medications with clinically significant anticholinergic activity.

RESULTS

According to the national surveys there were a total of 6.8 million (95% CI, 5.27-8.44 million; 0.32%) ambulatory care visits for dementia. Approximately 43% (42.86%; 95% CI, 35.24-50.48) of these visits involved prescribing at least one anticholinergic drug; and 10.07% of visits involved prescribing levels 2 or 3 anticholinergic medications. The predisposing factor, age (75-84 years; odds ratio [OR] = 0.25; 95% CI, 0.07-0.87), and the need factors, acetylcholinesterase inhibitor use (OR = 0.25; 95% CI, 0.07-0.86) and comorbid mood disorders (OR = 0.12; 95% CI, 0.02-0.73), were associated with decreased likelihood of prescribing medications with clinically significant anticholinergic activity. The need factor total number of medications prescribed (OR = 1.45, 95% CI, 1.20-1.75) increased the likelihood of these prescriptions being administered.

CONCLUSIONS

One in 10 outpatient visits by elderly persons with dementia involved prescribing medications with clinically significant anticholinergic activity. Given their adverse cognitive effects, there is a strong need to optimize anticholinergic drug prescribing in vulnerable elderly outpatients with dementia.

Authors+Show Affiliations

Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Texas Medical Center, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22030114

Citation

Bhattacharya, Rituparna, et al. "Prevalence and Predictors of Anticholinergic Agents in Elderly Outpatients With Dementia." The American Journal of Geriatric Pharmacotherapy, vol. 9, no. 6, 2011, pp. 434-41.
Bhattacharya R, Chatterjee S, Carnahan RM, et al. Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia. Am J Geriatr Pharmacother. 2011;9(6):434-41.
Bhattacharya, R., Chatterjee, S., Carnahan, R. M., & Aparasu, R. R. (2011). Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia. The American Journal of Geriatric Pharmacotherapy, 9(6), 434-41. https://doi.org/10.1016/j.amjopharm.2011.10.001
Bhattacharya R, et al. Prevalence and Predictors of Anticholinergic Agents in Elderly Outpatients With Dementia. Am J Geriatr Pharmacother. 2011;9(6):434-41. PubMed PMID: 22030114.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia. AU - Bhattacharya,Rituparna, AU - Chatterjee,Satabdi, AU - Carnahan,Ryan M, AU - Aparasu,Rajender R, Y1 - 2011/10/26/ PY - 2011/09/27/accepted PY - 2011/10/28/entrez PY - 2011/10/28/pubmed PY - 2012/3/31/medline SP - 434 EP - 41 JF - The American journal of geriatric pharmacotherapy JO - Am J Geriatr Pharmacother VL - 9 IS - 6 N2 - BACKGROUND: Anticholinergic medications, although frequently used in elderly populations, are associated with cognitive impairment and constitute significant concern for patients with dementia. OBJECTIVE: The purpose of our study was to examine patterns and predictors of prescribing anticholinergic agents for elderly outpatients with dementia. METHODS: We combined data from the 2006-2007 National Ambulatory Medical Care Survey and the outpatient department component of National Hospital Ambulatory Medical Care Survey to analyze patient visits by elderly persons (aged ≥65 years) with dementia. Anticholinergic drugs were identified using the Anticholinergic Drug Scale, which classifies anticholinergic drugs into four levels (0-3) in increasing order of anticholinergic activity. Descriptive analysis using sampling weights was used to evaluate patterns of anticholinergic drug prescription, especially prescribing of medications with clinically significant anticholinergic activity (ie, levels 2 or 3). Multiple logistic regression was used in the conceptual framework of the Andersen Behavioral Model to examine the predisposing, enabling, and need factors associated with prescribing of medications with clinically significant anticholinergic activity. RESULTS: According to the national surveys there were a total of 6.8 million (95% CI, 5.27-8.44 million; 0.32%) ambulatory care visits for dementia. Approximately 43% (42.86%; 95% CI, 35.24-50.48) of these visits involved prescribing at least one anticholinergic drug; and 10.07% of visits involved prescribing levels 2 or 3 anticholinergic medications. The predisposing factor, age (75-84 years; odds ratio [OR] = 0.25; 95% CI, 0.07-0.87), and the need factors, acetylcholinesterase inhibitor use (OR = 0.25; 95% CI, 0.07-0.86) and comorbid mood disorders (OR = 0.12; 95% CI, 0.02-0.73), were associated with decreased likelihood of prescribing medications with clinically significant anticholinergic activity. The need factor total number of medications prescribed (OR = 1.45, 95% CI, 1.20-1.75) increased the likelihood of these prescriptions being administered. CONCLUSIONS: One in 10 outpatient visits by elderly persons with dementia involved prescribing medications with clinically significant anticholinergic activity. Given their adverse cognitive effects, there is a strong need to optimize anticholinergic drug prescribing in vulnerable elderly outpatients with dementia. SN - 1876-7761 UR - https://www.unboundmedicine.com/medline/citation/22030114/Prevalence_and_predictors_of_anticholinergic_agents_in_elderly_outpatients_with_dementia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1543-5946(11)00172-3 DB - PRIME DP - Unbound Medicine ER -