Galveston, TX—
Drugs with anticholinergic properties can cause problems for the elderly. The medications block the action of the neurotransmitter acetylcholine and are used to treat conditions such as chronic obstructive pulmonary disease (COPD), bladder conditions, gastrointestinal disorders, and symptoms of Parkinson’s disease.

The drugs have a range of side effects—including dry mouth, blurred vision, dry eyes, constipation, urinary retention dizziness, confusion, and heart rhythm disturbance—and recent research has linked them to an increased risk of dementia in the elderly.

A recent study published in the Journal of the American Geriatrics Society sought to investigate the time course of anticholinergic drug use in nursing home residents and assess if any temporal change in anticholinergic use varied by nursing home quality rating.

Researchers from The University of Texas Medical Branch and colleagues conducted a retrospective repeated cross-sectional analysis of Medicare enrollment, Parts A, B, and D, claims data linked to the minimum data set from 2009 to 2017. Their focus was on Medicare-certified nursing homes.

Participants included long-term residents aged 65 years or older with nursing home stays of at least 100 consecutive days within a given calendar year.

To estimate anticholinergic drug prescription rates between 2009 and 2017, the study team used a binary variable indicating whether a resident received a drug with high anticholinergic activity, as defined by the Anticholinergic Cognitive Burden scale, for at least 1 day during the initial 100 consecutive days of nursing home stay in a given calendar year. 

The cohort included 786,858 100-day nursing home stays—299,354 unique residents—in 6,703 nursing homes for the years 2009 to 2017. 

Results indicate that prescription rates were stable at about 34% to 35% between 2009 and 2011, then gradually decreased to 24.3% in 2017 (P <.0001). Researchers emphasize that the decline was more pronounced in nursing homes having high quality ratings (P <.0001). 

In fact, rates for anticholinergic drugs in nursing homes with 4 to 5 star quality rating—which dropped from 33.7% in 2011 to 23.3% in 2017—showed a steeper decline over time relative to nursing homes with 1- to 2-star quality rating (34.2% in 2011 to 25.2% in 2017) (P <.0001).

“The use of drugs with high anticholinergic activity has declined from 2009 to 2017, with a greater decline in higher-quality nursing homes,” the authors concluded.

A study published last year in JAMA Internal Medicine sought to determine if the risk of dementia among those aged 55 years or older is associated with the use of different types of anticholinergic medication.

For the research, United Kingdom researchers from the University of Nottingham used a nested case-control study of 58,769 patients with a diagnosis of dementia and 225, 574 matched controls to determine that there were statistically significant associations of dementia risk with exposure to anticholinergic antidepressants, antiparkinson drugs, antipsychotic drugs, bladder antimuscarinics, and antiepileptic drugs after adjusting for confounding variables.

“The associations observed for specific types of anticholinergic medication suggest that these drugs should be prescribed with caution in middle-aged and older adults,” the authors write.
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