Anticholinergic Burden: Clinical Implications for Seniors and Strategies for Clinicians
DATA SOURCES: A MEDLINE/PubMed search was conducted from January 1990 to July 2011 using the terms anticholinergic, antimuscarinic, geriatric, aged, and elderly. References cited in studies and reviews identified in this search were also evaluated. Articles published in languages other than English or conducted in nonhuman species were not evaluated.
STUDY SELECTION: Studies and reviews were included if they evaluated adverse events associated with the use of AC medications in the older adult population.
DATA EXTRACTION: Data were extracted by the method of independent extraction by multiple observers based on their selection of sections.
DATA SYNTHESIS: The review presents evidence that AC medications are associated with negative outcomes in older adults and the importance of health care provider interventions to avoid these consequences.
CONCLUSION: AC burden is associated with adverse drug events and negative health outcomes in older adults. Health care providers should carefully assess the risks versus benefits of using medications with AC properties to minimize AC burden and prevent adverse outcomes in this vulnerable patient population. AC burden should be considered as acomponent of a medication therapy management program for seniors.
Keywords: 5-HMT = 5-hydroxy-methyl-tolterodine; AC = Anticholinergic; ACB = Anticholinergic Cognitive Burden; ADS = Anticholinergic Drug Scale; AE = Adverse event; Adverse drug events; Anticholinergic; Antimuscarinic; BVRT = Benton Visual Retention Test; CI = Confidence interval; CNS = Central nervous system; DBI = Drug Burden Index; EEG = Electroencephalogram; ER = Extended-release; Elderly; Geriatric; IR = Immediate-release; IST = Isaacs Set Test; MMSE = Mini-Mental State Examination; MTM = Medication therapy management; NNHS = National Nursing Home Survey; OAB = Overactive bladder; OR = Odds ratio; OTC = Over-the-counter; Older adult; PD = Parkinson's disease; QOL = Quality of life; SAA = Serum anticholinergic activity; SD = Standard deviation; START = Screening Tool to Alert doctors to Right Treatment; STOPP = Screening Tool of Older Person's potentially inappropriate Prescriptions; ng/mL = nanograms per milliliter; pmol/mL = Picomole per milliliter
Document Type: Research Article
Publication date: 01 August 2012
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