Temporal trends in anticholinergic medication prescription in older people: repeated cross-sectional analysis of population prescribing data

Deepa Sumukadas (Lead / Corresponding author), Marion E. T. McMurdo, Arduino A. Mangoni, Bruce Guthrie

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    44 Citations (Scopus)

    Abstract

    Background: in older people, medications with anticholinergic (antimuscarinic) effects are associated with adverse clinical outcomes, the risk increasing with increasing anticholinergic exposure. Many anticholinergics are recognised as potentially inappropriate and efforts to reduce prescription have been ongoing. We examined temporal trends of anticholinergic prescription and exposure in older people. Methods: anonymised data on all prescribed medication dispensed to people ≥65 years in Tayside, Scotland were obtained for the years 1995 (n = 67,608) and 2010 (n = 73,465). The Anticholinergic Risk Scale (ARS) was adapted (mARS) to include newer medications and medications identified in other scales as having moderate to strong anticholinergic activity. An individual's mARS score was the sum of scores for individual medications. Differences in prescription of anticholinergic medications and mARS scores between 1995 and 2010 were examined. Results: a significantly higher proportion of older people received any anticholinergic medication in 2010 compared with 1995 (23.7 versus 20.7%; P <0.001). High anticholinergic exposure (mARS scores ≥3) was seen in 7.3% in 1995 and 9.9% in 2010 (P < 0.001). Prescription of individual anticholinergic medication was small—only three medications were prescribed to >2% of people. The risk of high anticholinergic exposure increased in those with polypharmacy, social deprivation, those living in care homes and women. Conclusion: despite increasing evidence of adverse outcomes, the proportion of older people prescribed anticholinergic medications and the proportion with a high anticholinergic exposure has increased between 1995 and 2010. Prescription of individual drug is small so cumulative anticholinergic scores may help future efforts to reduce anticholinergic prescription in older people.
    Original languageEnglish
    Pages (from-to)515-521
    Number of pages7
    JournalAge and Ageing
    Volume43
    Issue number4
    Early online date10 Dec 2013
    DOIs
    Publication statusPublished - Jul 2014

    Fingerprint

    Cholinergic Antagonists
    Prescriptions
    Cross-Sectional Studies
    Population
    Polypharmacy
    Muscarinic Antagonists
    Prescription Drugs
    Scotland
    Home Care Services

    Keywords

    • anticholinergic medication
    • Older people
    • PRESCRIPTION

    Cite this

    @article{edf6744aaa2e4a1a8f683a1605e00053,
    title = "Temporal trends in anticholinergic medication prescription in older people: repeated cross-sectional analysis of population prescribing data",
    abstract = "Background: in older people, medications with anticholinergic (antimuscarinic) effects are associated with adverse clinical outcomes, the risk increasing with increasing anticholinergic exposure. Many anticholinergics are recognised as potentially inappropriate and efforts to reduce prescription have been ongoing. We examined temporal trends of anticholinergic prescription and exposure in older people. Methods: anonymised data on all prescribed medication dispensed to people ≥65 years in Tayside, Scotland were obtained for the years 1995 (n = 67,608) and 2010 (n = 73,465). The Anticholinergic Risk Scale (ARS) was adapted (mARS) to include newer medications and medications identified in other scales as having moderate to strong anticholinergic activity. An individual's mARS score was the sum of scores for individual medications. Differences in prescription of anticholinergic medications and mARS scores between 1995 and 2010 were examined. Results: a significantly higher proportion of older people received any anticholinergic medication in 2010 compared with 1995 (23.7 versus 20.7{\%}; P <0.001). High anticholinergic exposure (mARS scores ≥3) was seen in 7.3{\%} in 1995 and 9.9{\%} in 2010 (P < 0.001). Prescription of individual anticholinergic medication was small—only three medications were prescribed to >2{\%} of people. The risk of high anticholinergic exposure increased in those with polypharmacy, social deprivation, those living in care homes and women. Conclusion: despite increasing evidence of adverse outcomes, the proportion of older people prescribed anticholinergic medications and the proportion with a high anticholinergic exposure has increased between 1995 and 2010. Prescription of individual drug is small so cumulative anticholinergic scores may help future efforts to reduce anticholinergic prescription in older people.",
    keywords = "anticholinergic medication, Older people, PRESCRIPTION",
    author = "Deepa Sumukadas and McMurdo, {Marion E. T.} and Mangoni, {Arduino A.} and Bruce Guthrie",
    year = "2014",
    month = "7",
    doi = "10.1093/ageing/aft199",
    language = "English",
    volume = "43",
    pages = "515--521",
    journal = "Age and Ageing",
    issn = "0002-0729",
    publisher = "Oxford University Press",
    number = "4",

    }

    TY - JOUR

    T1 - Temporal trends in anticholinergic medication prescription in older people

    T2 - repeated cross-sectional analysis of population prescribing data

    AU - Sumukadas, Deepa

    AU - McMurdo, Marion E. T.

    AU - Mangoni, Arduino A.

    AU - Guthrie, Bruce

    PY - 2014/7

    Y1 - 2014/7

    N2 - Background: in older people, medications with anticholinergic (antimuscarinic) effects are associated with adverse clinical outcomes, the risk increasing with increasing anticholinergic exposure. Many anticholinergics are recognised as potentially inappropriate and efforts to reduce prescription have been ongoing. We examined temporal trends of anticholinergic prescription and exposure in older people. Methods: anonymised data on all prescribed medication dispensed to people ≥65 years in Tayside, Scotland were obtained for the years 1995 (n = 67,608) and 2010 (n = 73,465). The Anticholinergic Risk Scale (ARS) was adapted (mARS) to include newer medications and medications identified in other scales as having moderate to strong anticholinergic activity. An individual's mARS score was the sum of scores for individual medications. Differences in prescription of anticholinergic medications and mARS scores between 1995 and 2010 were examined. Results: a significantly higher proportion of older people received any anticholinergic medication in 2010 compared with 1995 (23.7 versus 20.7%; P <0.001). High anticholinergic exposure (mARS scores ≥3) was seen in 7.3% in 1995 and 9.9% in 2010 (P < 0.001). Prescription of individual anticholinergic medication was small—only three medications were prescribed to >2% of people. The risk of high anticholinergic exposure increased in those with polypharmacy, social deprivation, those living in care homes and women. Conclusion: despite increasing evidence of adverse outcomes, the proportion of older people prescribed anticholinergic medications and the proportion with a high anticholinergic exposure has increased between 1995 and 2010. Prescription of individual drug is small so cumulative anticholinergic scores may help future efforts to reduce anticholinergic prescription in older people.

    AB - Background: in older people, medications with anticholinergic (antimuscarinic) effects are associated with adverse clinical outcomes, the risk increasing with increasing anticholinergic exposure. Many anticholinergics are recognised as potentially inappropriate and efforts to reduce prescription have been ongoing. We examined temporal trends of anticholinergic prescription and exposure in older people. Methods: anonymised data on all prescribed medication dispensed to people ≥65 years in Tayside, Scotland were obtained for the years 1995 (n = 67,608) and 2010 (n = 73,465). The Anticholinergic Risk Scale (ARS) was adapted (mARS) to include newer medications and medications identified in other scales as having moderate to strong anticholinergic activity. An individual's mARS score was the sum of scores for individual medications. Differences in prescription of anticholinergic medications and mARS scores between 1995 and 2010 were examined. Results: a significantly higher proportion of older people received any anticholinergic medication in 2010 compared with 1995 (23.7 versus 20.7%; P <0.001). High anticholinergic exposure (mARS scores ≥3) was seen in 7.3% in 1995 and 9.9% in 2010 (P < 0.001). Prescription of individual anticholinergic medication was small—only three medications were prescribed to >2% of people. The risk of high anticholinergic exposure increased in those with polypharmacy, social deprivation, those living in care homes and women. Conclusion: despite increasing evidence of adverse outcomes, the proportion of older people prescribed anticholinergic medications and the proportion with a high anticholinergic exposure has increased between 1995 and 2010. Prescription of individual drug is small so cumulative anticholinergic scores may help future efforts to reduce anticholinergic prescription in older people.

    KW - anticholinergic medication

    KW - Older people

    KW - PRESCRIPTION

    U2 - 10.1093/ageing/aft199

    DO - 10.1093/ageing/aft199

    M3 - Article

    C2 - 24334709

    VL - 43

    SP - 515

    EP - 521

    JO - Age and Ageing

    JF - Age and Ageing

    SN - 0002-0729

    IS - 4

    ER -