Prevalence of Anticholinergic Use in Older People in England

Takeaway

• The prevalence of potent anticholinergic use in the older population in England nearly doubled over 20 years (from 1990-1993 to 2008-2011) largely because of the rising use of antidepressants and urologicals.
• The use was highest among groups most vulnerable to their side effects, including people living with clinically significant cognitive impairment.

Why this matters

• Anticholinergic medication use is associated with an increased risk of cognitive decline, dementia, falls and mortality, and their use should be limited in older people.
• Findings warrant further research to monitor their use within vulnerable populations, particularly older people living with clinically significant cognitive impairment in the UK since 2011 and in other countries.

Study design

• This study compared the prevalence of anticholinergic medication use in the older population (age, ≥65 years) in England using data from the Cognitive Function and Ageing Studies (CFAS I and CFAS II) during 1990-1993 (n=7635) and 2008-2011 (n=7762).
• Anticholinergic use was estimated in groups defined by age, sex, cognitive function (Mini-Mental State Examination [MMSE] ≤21, 22-25 and 26-30 points) and disability (measured by impairment in activities of daily living [ADL] and instrumental ADL [IADL]).
• Funding: Alzheimer’s Society.

Key results

• The prevalence of potent anticholinergic use in older population increased from 5.7% (95% CI, 5.2-6.3%) in 1990-1993 to 9.9% (95% CI, 9.3-10.7%) in 2008-2011 (adjusted OR [aOR], 1.90; 95% CI, 1.67-2.16).
• In CFAS II, heaviest users were those with clinically significant cognitive impairment (MMSE ≤21; 16.5% [95% CI, 12.0-22.3%]) and more disability (ADL disability: 20.8% [95% CI, 17.6-24.5%])
• The greatest rate of increase was seen in those with IADL disability from 6.8% (95% CI, 5.4-8.7%) in CFAS I to 15.8% (95% CI, 13.8-18.0%) in CFAS II (P_interaction=.05).
• Large increases in the prevalence of medication use with ‘any’ anticholinergic activity were observed in older people with significant cognitive impairment (from 53.3% [95% CI, 49.0-57.6%] in CFAS I to 71.5% [95% CI, 65.0-77.1%] in CFAS II) (P_interaction=.02).

Limitations

• The accuracy of the self-reported medication use and the duration of treatment were unknown.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.