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Use of Drugs with Anticholinergic Properties Among Nursing Home Residents with Dementia: A National Analysis of Medicare Beneficiaries from 2007 to 2008

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Abstract

Background

Older adults with dementia are vulnerable to the central deteriorating effects of drugs with anticholinergic properties (DAPs). These effects include falls and confusion and may exacerbate dementia-related symptoms. Many individuals with dementia also receive acetylcholinesterase inhibitors (AChEIs), indicated for mild to moderate Alzheimer’s disease. AChEIs have opposing effects to DAPs and, consequently, concomitant use of DAPs and AChEIs may further impair cognition among patients with dementia.

Objectives

Our objectives were to (1) evaluate the anticholinergic burden among nursing home (NH) residents with dementia; (2) characterize trends in use of DAPs and concomitant use of DAPs and AChEIs among NH residents with dementia; and (3) identify factors associated with the use of DAPs and concomitant use of DAPs and AChEIs.

Methods

We conducted a retrospective analysis of Medicare data from 2007 to 2008 linked to the Minimum Data Set.

Results

During the study period, 53,805 (77 %) NH residents with dementia used at least one DAP each month. Sixty-seven percent of residents with dementia used Anticholinergic Cognitive Burden Scale (ACBS) level 1 DAPs, 3 % used level 2 DAPs, and 31 % used level 3 DAPs. Thirteen percent of NH residents with dementia concomitantly used ACBS levels 2 or 3 DAPs and AChEIs.

Conclusions

This study sheds new light on the prevalence of DAP use and concomitant use of DAPs and AChEIs among NH residents with dementia. Clinicians should consider alternatives with lower anticholinergic effects, particularly in patients already taking DAPs.

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Acknowledgments

Drs. Palmer, Albrecht, Park, Dutcher, Rattinger, Simoni-Wastila, and Zuckerman, and Ms. Walker would like to thank Dr. Xingang Liu and Ms. Xian Shen for SAS® coding assistance and acknowledge Ms. Zippora Kiptanui for assistance with the IRB protocol. This work was supported in part by the Food and Drug Administration (Collaborative agreement U01FD004320). Dr. Albrecht is supported by National Institutes of Health grant T32AG000262-14 (J. Magaziner, Primary Investigator). Drs. Palmer and Park are supported by a fellowship grant from Novartis. The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA

    Jacqueline B. Palmer, Yujin Park, Sarah Dutcher, Linda Simoni-Wastila, Loreen D. Walker & Ilene H. Zuckerman

  2. Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 10 S. Pine St., MSTF 334C, Baltimore, MD, 21201, USA

    Jennifer S. Albrecht & Ilene H. Zuckerman

  3. Division of Pharmacy Practice, Fairleigh Dickinson University School of Pharmacy, Florham Park, NJ, USA

    Gail B. Rattinger

  4. IMPAQ International, LLC, Columbia, MD, USA

    Ilene H. Zuckerman

Authors
  1. Jacqueline B. Palmer
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  2. Jennifer S. Albrecht
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Correspondence to Jennifer S. Albrecht.

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Palmer, J.B., Albrecht, J.S., Park, Y. et al. Use of Drugs with Anticholinergic Properties Among Nursing Home Residents with Dementia: A National Analysis of Medicare Beneficiaries from 2007 to 2008. Drugs Aging 32, 79–86 (2015). https://doi.org/10.1007/s40266-014-0227-8

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  • DOI: https://doi.org/10.1007/s40266-014-0227-8

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