Are High-Risk Anticholinergic Medicines Prescribed Too Often for Older Adults?

Journal of the American Geriatrics Society Research Summary

Anticholinergics are a class of medications that are often prescribed for allergies, lung disease, and urinary incontinence. They also often can increase health risks for older adults. These medicines can affect your memory and ability to think, and they can even lead to increases in the risk for falls, dementia, and death. Additionally, older adults often have a difficult time tolerating anticholinergics because of age-related physical changes, such as reduced liver and kidney function, and because medications can impact our brain chemistry more strongly as we age.

Experts use tools to help older adults and healthcare professionals understand the risks associated with medications like anticholinergics. One of these tools is the AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The AGS Beers Criteria details medications with risks that may outweigh their benefits for older adults. The AGS Beers Criteria identifies 52 “high-risk” anticholinergics. Thirty-five of these are included on a list of medications worth avoiding altogether for older people, unless a healthcare professional has a compelling reason for prescribing them on a case-by-case basis.

Recently, a team of researchers decided to study how frequently healthcare providers prescribe potentially inappropriate medications like anticholinergics in light of recommendations like those from the AGS Beers Criteria. Their study was published in the Journal of the American Geriatrics Society.

 The researchers used information from the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), an annual survey of office-based physician visits. The researchers looked only at visits for people aged 65 or older.

The researchers focused on the 35 anticholinergics that healthcare professionals are advised to avoid for older adults. Among them were antidepressants, medications used to treat overactive bladder and Parkinson’s disease, antihistamines, muscle relaxants, and treatments for people who live with muscle spasms.

The researchers learned that between 2006 and 2015, 6.2 percent of older adult visits to a physician resulted in a prescription for a “high-risk” anticholinergic. Older women who had more than two chronic conditions were also the most likely to be prescribed potentially inappropriate anticholinergics. They were most often diagnosed with overactive bladder or urinary incontinence, nerve pain, dizziness, or motion sickness.

Interestingly, the researchers noted that the trend for prescribing these high-risk treatments had fallen by about 2 percent between 2008/2009 and 2014/2015.

The researchers concluded that their findings suggest that future research should be conducted to help create better care practices aimed at reducing the use of high-risk anticholinergic prescriptions for older adults.

Remember: Even if you’re currently taking an anticholinergic, never stop using a medication before speaking with a healthcare professional. For more information on medication management, click here.

 This summary is from “National Prescribing Trends of High-risk Anticholinergic Medications in Older Adults.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Taeho Greg Rhee, PhD, MSW; Yookyung Christy Choi, PharmD; Gregory M. Ouellet, MD; and Joseph S. Ross, MD, MHS.

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