JAMDA
Volume 10, Issue 4 , Pages 252-257 , May 2009

A Preliminary Study of Anticholinergic Burden and Relationship to a Quality of Life Indicator, Engagement in Activities, in Nursing Home Residents With Dementia

  • Ann Kolanowski, PhD, RN

      Affiliations

    • School of Nursing, Pennsylvania State University, University Park, PA
    • Corresponding Author InformationAddress correspondence to Ann Kolanowski, PhD, RN, School of Nursing, Pennsylvania State University, University Park, PA 16802.
  • ,
  • Donna M. Fick, PhD, GCNS-BC

      Affiliations

    • School of Nursing, Pennsylvania State University, University Park, PA
  • ,
  • Judy Campbell, MSN, ARNP

      Affiliations

    • College of Nursing, University of Florida, Gainesville, FL
  • ,
  • Mark Litaker, PhD

      Affiliations

    • School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
  • ,
  • Malaz Boustani, MD, MPH

      Affiliations

    • Indiana University Center for Aging Research, and Regenstrief Institute, Inc, Indianapolis, IN

References 

  1. Landi F, Russo A, Liperoti R, et al. Anticholinergic drugs and physical function among frail elderly population. Clin Pharmacol Ther. 2007;81:235–241
  2. Ellul J, Archer N, Foy CM, et al. The effects of commonly prescribed drugs in patients with Alzheimer's disease on the rate of deterioration. J Neurol Neurosurg Psychiatry. 2007;78:233–239
  3. Ness J, Hoth A, Barnett MJ, et al. Anticholinergic medications in community-dwelling older veterans: Prevalence of anticholinergic symptoms, symptom burden, and adverse drug events. Am J Geriatr Pharmacother. 2006;4:42–51
  4. Sink KM, Thomas J, Xu H, et al. Dual use of bladder anticholinergics and cholinesterase inhibitors: Long-term functional and cognitive outcomes. J Am Geriatr Soc. 2008;56:847–853
  5. Lawton MP. Quality of life in Alzheimer disease. Alzheimer Dis Assoc Disord. 1994;8:138–150
  6. Kolanowski AM, Litaker M, Buettner L. Efficacy of theory-based activities for behavioral symptoms of dementia. Nurs Res. 2005;54:219–228
  7. Teri L, Gibbons LE, McCurry SM, et al. Exercise plus behavioral management in patients with Alzheimer disease: A randomized controlled trial. JAMA. 2003;290:2015–2022
  8. Richards KC, Beck C, O'Sullivan PS, Shue VM. Effect of individualized social activity on sleep in nursing home residents with dementia. J Am Geriatr Soc. 2005;53:1510–1517
  9. Schnelle JF, Alessi CA, Simmons SF, et al. Translating clinical research into practice: A randomized controlled trial of exercise and incontinence care with nursing home residents. J Am Geriatr Soc. 2002;50:1476–1483
  10. Mor V, Branco K, Fleishman J, et al. The structure of social engagement among nursing home residents. J Gerontol B Psychol Sci Soc Sci. 1995;50:P1–P8
  11. Ballard C, O'Brien J, James I, et al. Quality of life for people with dementia living in residential and nursing home care: The impact of performance on activities of daily living, behavioral and psychological symptoms, language skills, and psychotropic drugs. Int Psychogeriatr. 2001;13:93–106
  12. Handler SM, Wright RM, Ruby CM, Hanlon JT. Epidemiology of medication-related adverse events in nursing homes. Am J Geriatr Pharmacother. 2006;4:264–272
  13. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716–2724
  14. Mulsant BH, Pollock BG, Kirshner M, et al. Serum anticholinergic activity in a community-based sample of older adults: Relationship with cognitive performance. Arch Gen Psychiatry. 2003;60:198–203
  15. Carnahan RM, Lund BC, Perry PJ, et al. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: Associations with serum anticholinergic activity. J Clin Pharmacol. 2006;46:1481–1486
  16. Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168:508–513
  17. Boustani MA, Campbell N, Munger S, et al. Impact of anticholinergics on the aging brain: A review and practical application. Aging Health. 2008;4:311–320
  18. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198
  19. Wilkinson IM, Graham-White J. Psychogeriatric dependency rating scales (PGDRS): A method of assessment for use by nurses. Br J Med Hypn. 1980;137:558–565
  20. Jones A. The National Nursing Home Survey: 1999 summary. Vital Health Stat. 2002;152:1–116
  21. Cohen-Mansfield J, Marx M, Rosenthal S. A description of agitation in a nursing home. J Gerontol. 1989;44:M77–M84
  22. Colling K. A taxonomy of passive behaviors in people with Alzheimer's disease. Image. J Nurs Scholarsh. 2000;32:239–244
  23. Nolan M, Grant G, Nolan J. Busy doing nothing: Activity and interaction levels amongst differing populations of elderly patients. J Adv Nurs. 1995;22:528–538
  24. Kolanowski A, Litaker M. Social interaction, premorbid personality, and agitation in nursing home residents with dementia. Arch Psychiatr Nurs. 2006;20:12–20
  25. Logsdon R. Behavioral outcomes of dementia special care units: Results from four of the NIA collaborative studies. Paper presented at the symposium, Behavioral Findings, Measures, and Clinical Approaches to Dementia Care at the 53rd Annual Scientific Meeting of the Gerontological Society of America. Washington, DC: Gerontologist; 2000;40:133
  26. MacRae P, Schnelle J, Ouslander J. Physical activity levels of ambulatory nursing home residents. J Am Psychoanal Assoc. 1996;4:264–278
  27. Rovner BW, Steele CD, Shmuely Y, Folstein MF. A randomized trial of dementia care in nursing homes. J Am Geriatr Soc. 1996;44:7–13
  28. Resnick HE, Fries BE, Verbrugge LM. Windows to their world: The effect of sensory impairments on social engagement and activity time in nursing home residents. J Gerontol B Psychol Sci Soc Sci. 1997;52:S135–S144
  29. Nebes RD, Pollock BG, Halligan EM, et al. Serum anticholinergic activity and motor performance in elderly persons. J Gerontol A Biol Sci Med Sci. 2007;62:83–85
  30. Cao YJ, Mager DE, Simonsick EM, et al. Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clin Pharmacol Ther. 2008;83:422–429
  31. Schubert CC, Boustani M, Callahan CM, et al. Comorbidity profile of dementia patients in primary care: Are they sicker?. J Am Geriatr Soc. 2006;54:104–109
  32. Tune LE, Egeli S. Acetylcholine and delirium. Dement Geriatr Cogn Disord. 1999;10:342–344

 A.K. acknowledges support from The National Institute of Nursing Research: R01 NR008910.

 D.M.F. is supported in part by a grant from the National Institute on Aging: R03 AG023216.

 J.C. acknowledges support from the Hartford Building Academic Geriatric Nursing Capacity Scholarship and the University of Florida Alumni Fellowship. M.B. is supported by a grant (K23 AG 26770–01) from the John A. Hartford Foundation, the Atlantic Philanthropies, the Starr Foundation, and the National Institute on Aging.

PII: S1525-8610(08)00424-6

doi: 10.1016/j.jamda.2008.11.005

JAMDA
Volume 10, Issue 4 , Pages 252-257 , May 2009