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Features of anticholinergic prescriptions and predictors of high use in the elderly: Population-based study.
Pharmacoepidemiol Drug Saf. 2019 12; 28(12):1591-1600.PD

Abstract

PURPOSE

Older people are especially vulnerable to negative anticholinergic effects. Although anticholinergic drugs are commonly used among older people, drugs with potent antimuscarinic properties are considered as potentially inappropriate medications for older people. Here, we examined features of anticholinergic use and investigated predictors for the high use of strong anticholinergic agents (ACs) in the elderly.

METHODS

A total of 388,629 Korean elderly aged ≥70 years were recruited from the 2012 National Health Insurance Service Elderly cohort database. The use of ACs in 2012 was quantitatively assessed by calculating standardized prescribed doses. Multivariate logistic regression was conducted to identify predictors of the high use of strong ACs (≥90 doses).

RESULTS

Almost half of the subjects (47.2%) used more than 15 doses of strong ACs during 2012. 17.0% of the subjects had an annual cumulative use of strong ACs over 90 doses. Morbidities such as depression (odds ratio [OR], 95% confidence interval [CI] = 2.56, 2.48-2.63), Parkinson's disease (2.41, 2.26-2.56), genitourinary diseases (2.12, 2.07-2.16), polypharmacy (3.28, 3.21-3.36), and low income (1.29, 1.25-1.33) were strong predictors of their high use. Antihistamines (chlorpheniramine) and antidepressants (amitriptyline) greatly contributed to the total prescription of strong ACs.

CONCLUSIONS

Despite the vulnerability of older people to the adverse reactions of strong ACs, their use seems to be at a high level in terms of cumulative usage among some elderly. More attention should be paid to older people with predictive factors of high use of strong ACs. Key points Despite the susceptibility of older people to negative anticholinergic effects, high use of strong anticholinergic agents was is quite frequent; 17.0% of the elderly had an annual cumulative use of these drugs ≥90 doses. Parkinson's disease, depression, genitourinary diseases, low income, and polypharmacy strongly predicted the high use of strong anticholinergic agents. A few strong anticholinergic agents, including antihistamines (chlorpheniramine) and antidepressants (amitriptyline), accounted for the majority of medications prescribed. Understanding the predictors of their high use by medical practitioners may result as more appropriate anticholinergic medications.

Authors+Show Affiliations

Division of Epidemiology, Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea.School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, South Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31692168

Citation

Joung, Kyung-In, et al. "Features of Anticholinergic Prescriptions and Predictors of High Use in the Elderly: Population-based Study." Pharmacoepidemiology and Drug Safety, vol. 28, no. 12, 2019, pp. 1591-1600.
Joung KI, Shin JY, Cho SI. Features of anticholinergic prescriptions and predictors of high use in the elderly: Population-based study. Pharmacoepidemiol Drug Saf. 2019;28(12):1591-1600.
Joung, K. I., Shin, J. Y., & Cho, S. I. (2019). Features of anticholinergic prescriptions and predictors of high use in the elderly: Population-based study. Pharmacoepidemiology and Drug Safety, 28(12), 1591-1600. https://doi.org/10.1002/pds.4902
Joung KI, Shin JY, Cho SI. Features of Anticholinergic Prescriptions and Predictors of High Use in the Elderly: Population-based Study. Pharmacoepidemiol Drug Saf. 2019;28(12):1591-1600. PubMed PMID: 31692168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Features of anticholinergic prescriptions and predictors of high use in the elderly: Population-based study. AU - Joung,Kyung-In, AU - Shin,Ju-Young, AU - Cho,Sung-Il, Y1 - 2019/11/06/ PY - 2019/05/01/received PY - 2019/08/07/revised PY - 2019/09/09/accepted PY - 2019/11/7/pubmed PY - 2020/7/28/medline PY - 2019/11/7/entrez KW - National Health Insurance Service (NHIS) KW - anticholinergic agent KW - elderly cohort KW - high use KW - potentially inappropriate medication KW - prescribed amount KW - the elderly SP - 1591 EP - 1600 JF - Pharmacoepidemiology and drug safety JO - Pharmacoepidemiol Drug Saf VL - 28 IS - 12 N2 - PURPOSE: Older people are especially vulnerable to negative anticholinergic effects. Although anticholinergic drugs are commonly used among older people, drugs with potent antimuscarinic properties are considered as potentially inappropriate medications for older people. Here, we examined features of anticholinergic use and investigated predictors for the high use of strong anticholinergic agents (ACs) in the elderly. METHODS: A total of 388,629 Korean elderly aged ≥70 years were recruited from the 2012 National Health Insurance Service Elderly cohort database. The use of ACs in 2012 was quantitatively assessed by calculating standardized prescribed doses. Multivariate logistic regression was conducted to identify predictors of the high use of strong ACs (≥90 doses). RESULTS: Almost half of the subjects (47.2%) used more than 15 doses of strong ACs during 2012. 17.0% of the subjects had an annual cumulative use of strong ACs over 90 doses. Morbidities such as depression (odds ratio [OR], 95% confidence interval [CI] = 2.56, 2.48-2.63), Parkinson's disease (2.41, 2.26-2.56), genitourinary diseases (2.12, 2.07-2.16), polypharmacy (3.28, 3.21-3.36), and low income (1.29, 1.25-1.33) were strong predictors of their high use. Antihistamines (chlorpheniramine) and antidepressants (amitriptyline) greatly contributed to the total prescription of strong ACs. CONCLUSIONS: Despite the vulnerability of older people to the adverse reactions of strong ACs, their use seems to be at a high level in terms of cumulative usage among some elderly. More attention should be paid to older people with predictive factors of high use of strong ACs. Key points Despite the susceptibility of older people to negative anticholinergic effects, high use of strong anticholinergic agents was is quite frequent; 17.0% of the elderly had an annual cumulative use of these drugs ≥90 doses. Parkinson's disease, depression, genitourinary diseases, low income, and polypharmacy strongly predicted the high use of strong anticholinergic agents. A few strong anticholinergic agents, including antihistamines (chlorpheniramine) and antidepressants (amitriptyline), accounted for the majority of medications prescribed. Understanding the predictors of their high use by medical practitioners may result as more appropriate anticholinergic medications. SN - 1099-1557 UR - https://www.unboundmedicine.com/medline/citation/31692168/Features_of_anticholinergic_prescriptions_and_predictors_of_high_use_in_the_elderly:_Population_based_study_ L2 - https://doi.org/10.1002/pds.4902 DB - PRIME DP - Unbound Medicine ER -