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Use of drugs with anticholinergic properties among nursing home residents with dementia: a national analysis of Medicare beneficiaries from 2007 to 2008.
Drugs Aging. 2015 Jan; 32(1):79-86.DA

Abstract

BACKGROUND

Older adults with dementia are vulnerable to the central deteriorating effects of drugs with anticholinergic properties (DAPs). These effects include falls and confusion and may exacerbate dementia-related symptoms. Many individuals with dementia also receive acetylcholinesterase inhibitors (AChEIs), indicated for mild to moderate Alzheimer's disease. AChEIs have opposing effects to DAPs and, consequently, concomitant use of DAPs and AChEIs may further impair cognition among patients with dementia.

OBJECTIVES

Our objectives were to (1) evaluate the anticholinergic burden among nursing home (NH) residents with dementia; (2) characterize trends in use of DAPs and concomitant use of DAPs and AChEIs among NH residents with dementia; and (3) identify factors associated with the use of DAPs and concomitant use of DAPs and AChEIs.

METHODS

We conducted a retrospective analysis of Medicare data from 2007 to 2008 linked to the Minimum Data Set.

RESULTS

During the study period, 53,805 (77%) NH residents with dementia used at least one DAP each month. Sixty-seven percent of residents with dementia used Anticholinergic Cognitive Burden Scale (ACBS) level 1 DAPs, 3% used level 2 DAPs, and 31% used level 3 DAPs. Thirteen percent of NH residents with dementia concomitantly used ACBS levels 2 or 3 DAPs and AChEIs.

CONCLUSIONS

This study sheds new light on the prevalence of DAP use and concomitant use of DAPs and AChEIs among NH residents with dementia. Clinicians should consider alternatives with lower anticholinergic effects, particularly in patients already taking DAPs.

Authors+Show Affiliations

Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

25491558

Citation

Palmer, Jacqueline B., et al. "Use of Drugs With Anticholinergic Properties Among Nursing Home Residents With Dementia: a National Analysis of Medicare Beneficiaries From 2007 to 2008." Drugs & Aging, vol. 32, no. 1, 2015, pp. 79-86.
Palmer JB, Albrecht JS, Park Y, et al. Use of drugs with anticholinergic properties among nursing home residents with dementia: a national analysis of Medicare beneficiaries from 2007 to 2008. Drugs Aging. 2015;32(1):79-86.
Palmer, J. B., Albrecht, J. S., Park, Y., Dutcher, S., Rattinger, G. B., Simoni-Wastila, L., Walker, L. D., & Zuckerman, I. H. (2015). Use of drugs with anticholinergic properties among nursing home residents with dementia: a national analysis of Medicare beneficiaries from 2007 to 2008. Drugs & Aging, 32(1), 79-86. https://doi.org/10.1007/s40266-014-0227-8
Palmer JB, et al. Use of Drugs With Anticholinergic Properties Among Nursing Home Residents With Dementia: a National Analysis of Medicare Beneficiaries From 2007 to 2008. Drugs Aging. 2015;32(1):79-86. PubMed PMID: 25491558.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of drugs with anticholinergic properties among nursing home residents with dementia: a national analysis of Medicare beneficiaries from 2007 to 2008. AU - Palmer,Jacqueline B, AU - Albrecht,Jennifer S, AU - Park,Yujin, AU - Dutcher,Sarah, AU - Rattinger,Gail B, AU - Simoni-Wastila,Linda, AU - Walker,Loreen D, AU - Zuckerman,Ilene H, PY - 2014/12/11/entrez PY - 2014/12/11/pubmed PY - 2016/3/12/medline SP - 79 EP - 86 JF - Drugs & aging JO - Drugs Aging VL - 32 IS - 1 N2 - BACKGROUND: Older adults with dementia are vulnerable to the central deteriorating effects of drugs with anticholinergic properties (DAPs). These effects include falls and confusion and may exacerbate dementia-related symptoms. Many individuals with dementia also receive acetylcholinesterase inhibitors (AChEIs), indicated for mild to moderate Alzheimer's disease. AChEIs have opposing effects to DAPs and, consequently, concomitant use of DAPs and AChEIs may further impair cognition among patients with dementia. OBJECTIVES: Our objectives were to (1) evaluate the anticholinergic burden among nursing home (NH) residents with dementia; (2) characterize trends in use of DAPs and concomitant use of DAPs and AChEIs among NH residents with dementia; and (3) identify factors associated with the use of DAPs and concomitant use of DAPs and AChEIs. METHODS: We conducted a retrospective analysis of Medicare data from 2007 to 2008 linked to the Minimum Data Set. RESULTS: During the study period, 53,805 (77%) NH residents with dementia used at least one DAP each month. Sixty-seven percent of residents with dementia used Anticholinergic Cognitive Burden Scale (ACBS) level 1 DAPs, 3% used level 2 DAPs, and 31% used level 3 DAPs. Thirteen percent of NH residents with dementia concomitantly used ACBS levels 2 or 3 DAPs and AChEIs. CONCLUSIONS: This study sheds new light on the prevalence of DAP use and concomitant use of DAPs and AChEIs among NH residents with dementia. Clinicians should consider alternatives with lower anticholinergic effects, particularly in patients already taking DAPs. SN - 1179-1969 UR - https://www.unboundmedicine.com/medline/citation/25491558/Use_of_drugs_with_anticholinergic_properties_among_nursing_home_residents_with_dementia:_a_national_analysis_of_Medicare_beneficiaries_from_2007_to_2008_ L2 - https://dx.doi.org/10.1007/s40266-014-0227-8 DB - PRIME DP - Unbound Medicine ER -