Abstract
Introduction
Older age is associated with multimorbidity and polypharmacy with high anticholinergic
burden (ACB). High ACB is linked to adverse events such as poor physical functioning,
dementia, cardiovascular disease, and falls. Interventions are needed to reduce this
burden.
Aims/Objectives
The aim was to systematically review the literature to identify and describe studies
of clinical and cost-effectiveness of interventions designed to reduce ACB in adults
(≥65 years) on polypharmacy regimes, compared with usual care. The objective was to
answer the following questions: What are the contents of the interventions? Were these
interventions clinically effective? Were these interventions cost effective?.
Design, setting, and participants
Systematic review of interventions to reduce anticholinergic burden in adults aged
65 and older in any clinical setting.
Methods
Eligible papers reported primary or secondary research describing any type of intervention
including systematic reviews, randomized controlled trials (RCTs), controlled clinical
trials, or nonrandomized pre-post intervention studies (PPIs) published in English
from January 2010 to February 2019. Databases searched included CINAHL, Ovid MEDLINE,
EMBASE, and The Cochrane Central Register of Controlled Trials (CENTRAL).
Results
The search yielded 5862 records. Eight studies (4 RCTs, 4 PPIs) conducted in hospital
(4), community (2), nursing homes (1), and retirement villages (1) met the inclusion
criteria. Pharmacists, either individually or as part of a team, provided the intervention
in the majority of studies (6/8). Most (7/8) involved individual patient medication
review followed by feedback to the prescriber. Two of the 4 RCTs and all non-RCTs
reported a decrease in ACB following the intervention. No study reported cost outcome.
Conclusions/Implications
Pharmacists may be well placed to implement an ACB reduction intervention. This is
the first systematic review of interventions to reduce ACB in older adults, and it
highlights the need for development and testing of high-quality pragmatic clinical
and cost-effectiveness trials in community and specific patient populations at high
risk of harm from ACB.
[PROSPERO registration: CRD42018089764].
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Anticholinergic drug burden in older people's brain—How well is it measured?.Basic Clin Pharmacol Toxicol. 2014; 114: 151-159
- The anticholinergic drug scale as a measure of drug-related anticholinergic burden: Associations with serum anticholinergic activity.J Clin Pharmacol. 2006; 46: 1481-1486
- The anticholinergic risk scale and anticholinergic adverse effects in older persons.Arch Intern Med. 2008; 168: 508-513
- Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: Longitudinal cohort study.Br Med J. 2006; 332: 455-459
- Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: A cohort study.J Neurol Neurosurg Psychiatry. 2010; 81: 160-165
- Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: A systematic review.Age Ageing. 2014; 43: 604-615
- A high anticholinergic burden is associated with a history of falls in the previous year in middle-aged women: Findings from the Aberdeen Prospective Osteoporosis Screening Study.Ann Epidemiol. 2018; 28: 557-562
- Systematic Reviews CRD's Guidance for Undertaking Review in Health Care.1st ed. York Publishing Services, York, UK2009
- Higgins J.P.T. Green S. Cochrane Handbook for Systematic Reviews of Interventions. 1st ed. John Wiley & Sons Ltd, West Sussex2008
- Preferred reporting Items for systematic reviews and meta-analyses: The PRISMA statement.Ann Intern Med. 2009; 151: 264-269
- Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide.BMJ. 2014; 348: 1-12
- CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials.J Clin Epidemiol. 2010; 63: 834-840
- The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies.Ann Intern Med. 2007; 147: 573-577
- Critical Appraisal Notes and Checklists.Scottish Intercollegiate Guidelines Network, Edinburgh, UK2018
- A pilot randomised clinical trial utilising the drug burden index to reduce exposure to anticholinergic and sedative medications in older people.Ann Pharmacother. 2010; 44: 1725-1732
- Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: A randomised controlled trial.J Gerontol A Biol Sci Med Sci. 2013; 68: 271-278
- Optimising medication appropriateness in older adults: A randomised clinical interventional trial to decrease anticholinergic burden.Alzheimers Res Ther. 2017; 9: 36
- Drug burden index and potentially inappropriate medications in community-dwelling older people: The impact of home medicines review.Drugs Aging. 2010; 27: 135-148
- Evaluation of a pharmacist-led pilot service based on the anticholinergic risk scale.J Am Pharm Assoc. 2016; 56: 555-561
- Reduction of anticholinergic burden in older patients admitted to a multidisciplinary geriatric acute care unit.Eur Geriatr Med. 2017; 8: 492-495
- Minimising anticholinergic drug prescribing in older hospitalised patients: A full audit cycle.Ther Adv Drug Saf. 2014; 5: 121-128
Van Der Meer HG, Wouters H, Pras N, Taxis K. Reducing patients' cumulative exposure to anticholinergic and sedative medication with medication reviews: A randomised controlled trial. Paper presented at: Pharmacoepidemiology and Drug Safety. Conference: 32nd International Conference on Pharmacoepidemiology and Therapeutic Risk Management; Dublin, Ireland; August 25-28, 2016.
- Impact of deprescribing interventions in older hospitalised patients on prescribing and clinical outcomes: A systematic review of randomised trials.Drugs Aging. 2018; 35: 303-319
- The feasibility and effect of deprescribing in older adults on mortality and health: A systematic review and meta-analysis.Br J Clin Pharmacol. 2016; 82: 583-623
- Impact of strategies to reduce polypharmacy on clinically relevant endpoints: A systematic review and meta-analysis.Br J Clin Pharmacol. 2016; 82: 532-548
- Anticholinergic drug use and risk of cognitive performance in older adults with questionable cognitive impairment: A cross-sectional analysis.Drugs Aging. 2016; 33: 809-818
Article info
Publication history
Published online: July 24, 2019
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
