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Potentially Inappropriate Medications and Anticholinergic Burden in Older People Attending Memory Clinics in Australia

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Abstract

Background

There has been limited research into potentially inappropriate medication (PIM) use and anticholinergic burden in patients attending memory clinics.

Objectives

The aim of this study was to explore the use of PIMs related to cognitive impairment (PIMcog), anticholinergic cognitive burden (ACB) and concomitant use of anticholinergic medications with cholinesterase inhibitors (ChEIs) in patients attending memory clinics.

Methods

Cross-sectional analysis of baseline data from the Prospective Research In MEmory clinics (PRIME) study was performed. Participants were community-dwelling patients who attended nine memory clinics and had a diagnosis of mild cognitive impairment or dementia. PIMcog were defined as any medication considered potentially inappropriate for patients with cognitive impairment according to the Beers or STOPP criteria. Clinically significant ACB was defined as total score of ≥3 on the ACB scale.

Results

A total of 964 patients, mean age 77.6 years, were included. PIMcog were used by 206 (21.4 %) patients. Anticholinergics and sedatives were the most common PIMcog. PIMcog use was associated with higher number of medications (adjusted OR 1.26; 95 % CI 1.19–1.33) and with not having completed secondary level education (adjusted OR 1.71; 95 % CI 1.01–2.89). One hundred and thirteen (11.7 %) patients had a clinically significant ACB score (≥3). ChEIs were used by 575 patients and 65 (11.3 %) of these had an ACB score ≥3. There was no statistically significant difference in ChEI use between patients with and without an ACB score ≥3.

Conclusion

PIMcog use, clinically significant anticholinergic burden, and concurrent use of anticholinergics with ChEIs were prevalent in patients attending memory clinics. Efforts are needed to improve prescribing for people with cognitive impairment.

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Acknowledgments

We thank all the Australian investigators, study nurses, staff and hospitals who comprise the PRIME study group: Prince of Wales Hospital (Marika Donkin, Kim Burns, Katrin Seeher); The Queen Elizabeth Hospital (Shelley Casey, Trish Steventon); St George’s Hospital (Maree Mastwyk, Alissa Westphal, Nicola Lautenschlager, Olga Yastrubetskaya, Marilyn Kemp, Edmond Chiu and Jenifer Ames); Austin Health Repatriation Hospital (Irene Tan, Henry Zeimer, Leonie Johnston); Hornsby Ku Ring Gai Hospital (Sue Kurrle, Roseanne Hogarth, Judith Allan); Fremantle Hospital (Roger Clarnette, Janice Guy, Denae Clark); The Prince Charles Hospital (Chris Davis, Mary Wyatt, Katrina Brosnan, Margaret Morton); Rankin Park Hospital (John Ward, Jeanette Gatgens); Geelong Private Hospital (Alastair Mander, Bernadine Charles).

Author information

Authors and Affiliations

  1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia

    Amanda J. Cross, Johnson George, Jenni Ilomäki & Rohan A. Elliott

  2. Medical and Cognitive Research Unit, Austin Health, Heidelberg, VIC, Australia

    Michael C. Woodward

  3. National Ageing Research Institute, Parkville, VIC, Australia

    David Ames

  4. University of Melbourne Academic Unit for Psychiatry of Old Age, St George’s Hospital, Kew, VIC, Australia

    David Ames

  5. Dementia Collaborative Research Centre, School of Psychiatry, University of NSW, Sydney, NSW, Australia

    Henry Brodaty

  6. Centre for Healthy Brain Ageing, School of Psychiatry, University of NSW, Sydney, NSW, Australia

    Henry Brodaty

  7. Pharmacy Department, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia

    Rohan A. Elliott

Authors
  1. Amanda J. Cross
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  2. Johnson George
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  3. Michael C. Woodward
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  4. David Ames
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  5. Henry Brodaty
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  6. Jenni Ilomäki
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  7. Rohan A. Elliott
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Corresponding author

Correspondence to Rohan A. Elliott.

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Funding

The PRIME study was supported by Janssen-Cilag Pty Ltd Australia. The funders had no role in the design, execution, analysis, interpretation, or writing of this study.

Conflict of interest

Amanda Cross, Johnson George, Michael Woodward, David Ames, Henry Brodaty, Jenni Ilomäki and Rohan Elliott declare that they have no conflicts of interest relevant to the content of this study.

Ethical approval

The PRIME study was approved by the research ethics committees of each participating institution and was conducted in accordance with the ethical standards of that committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all participants or their legal guardian/proxy and their carer.

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Cross, A.J., George, J., Woodward, M.C. et al. Potentially Inappropriate Medications and Anticholinergic Burden in Older People Attending Memory Clinics in Australia. Drugs Aging 33, 37–44 (2016). https://doi.org/10.1007/s40266-015-0332-3

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  • DOI: https://doi.org/10.1007/s40266-015-0332-3

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