ESTABLISHING GUIDELINES FOR ALTERNATIVES TO ANTICHOLINERGIC MEDICATIONS IN OLDER ADULTS WITH DEMENTIA

Sharmin Bala, Hamish Jamieson, Prasad Nishtala, Rhiannon Braund

Research output: Contribution to journalMeeting abstract

Abstract

Background
Anticholinergic agents are known to be associated with worsening of cognitive impairment in individuals diagnosed with dementia. With the aid of the international Resident Assessment Instrument-home care (interRAI-HC) tool, we observed a high prevalence of prescribing potentially inappropriate medications in older adults with dementia, especially the anticholinergic class of medications.

Methods
Based on the current literature review of the anticholinergic burden scales and serum anticholinergic activity of various medications, we developed a guideline for prescribers, focusing on pharmacological alternatives for the currently prescribed anticholinergic class of medications for older adults with dementia presenting with co-morbidities. The guidelines has been prepared referring to the medications listed in the New Zealand drug formulary. Medications were classified according to the ATC-DDD Index 2019. The health conditions were grouped according to the International Statistical Classification of Diseases and Related Health Problems. Medications were sorted according to the high/moderate anticholinergic activity and their low/no anticholinergic activity substitutes.

Results
With respect to the medications prescribed for disorders of the central nervous system, of the 117 analysed, 38% were grouped as medications with high or moderate anticholinergic activity (HOMAA), and 56% were found to have low or no anticholinergic activity (LONAA). Similarly, for the gastrointestinal, cardiovascular, respiratory, endocrine, genito-urinary system, and infections; we observed that of all prescribed medications, those which were observed to have HOMAA constituted 28%, 3%, 46%, 0, 5%, 30% respectively, and the medications which had LONAA comprised 48%, 56%, 43%, 62%, 43%, 70% respectively. The medications with HOMAA could be effectively replaced by their LONAA alternatives to ensure safe pharmacotherapy.

Conclusions
The application of the guidelines for prescribing alternatives to anticholinergic medications in this vulnerable population has the potential to reduce untoward effects associated with the prescription of anticholinergic medications, slower cognitive decline, and decrease the risk of mortality. Our next step in this ongoing research will aim at utilizing the interRAI-HC assessments for validating the guidelines in older adults with dementia.
Original languageEnglish
Pages (from-to)P1567-P1568
Number of pages2
JournalAlzheimer's & Dementia
Volume15
Issue number7, Supplement
DOIs
Publication statusE-pub ahead of print - 18 Oct 2019

Cite this

ESTABLISHING GUIDELINES FOR ALTERNATIVES TO ANTICHOLINERGIC MEDICATIONS IN OLDER ADULTS WITH DEMENTIA. / Bala, Sharmin; Jamieson, Hamish; Nishtala, Prasad; Braund, Rhiannon.

In: Alzheimer's & Dementia , Vol. 15, No. 7, Supplement, 18.10.2019, p. P1567-P1568.

Research output: Contribution to journalMeeting abstract

Bala, Sharmin ; Jamieson, Hamish ; Nishtala, Prasad ; Braund, Rhiannon. / ESTABLISHING GUIDELINES FOR ALTERNATIVES TO ANTICHOLINERGIC MEDICATIONS IN OLDER ADULTS WITH DEMENTIA. In: Alzheimer's & Dementia . 2019 ; Vol. 15, No. 7, Supplement. pp. P1567-P1568.
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title = "ESTABLISHING GUIDELINES FOR ALTERNATIVES TO ANTICHOLINERGIC MEDICATIONS IN OLDER ADULTS WITH DEMENTIA",
abstract = "BackgroundAnticholinergic agents are known to be associated with worsening of cognitive impairment in individuals diagnosed with dementia. With the aid of the international Resident Assessment Instrument-home care (interRAI-HC) tool, we observed a high prevalence of prescribing potentially inappropriate medications in older adults with dementia, especially the anticholinergic class of medications.MethodsBased on the current literature review of the anticholinergic burden scales and serum anticholinergic activity of various medications, we developed a guideline for prescribers, focusing on pharmacological alternatives for the currently prescribed anticholinergic class of medications for older adults with dementia presenting with co-morbidities. The guidelines has been prepared referring to the medications listed in the New Zealand drug formulary. Medications were classified according to the ATC-DDD Index 2019. The health conditions were grouped according to the International Statistical Classification of Diseases and Related Health Problems. Medications were sorted according to the high/moderate anticholinergic activity and their low/no anticholinergic activity substitutes.ResultsWith respect to the medications prescribed for disorders of the central nervous system, of the 117 analysed, 38{\%} were grouped as medications with high or moderate anticholinergic activity (HOMAA), and 56{\%} were found to have low or no anticholinergic activity (LONAA). Similarly, for the gastrointestinal, cardiovascular, respiratory, endocrine, genito-urinary system, and infections; we observed that of all prescribed medications, those which were observed to have HOMAA constituted 28{\%}, 3{\%}, 46{\%}, 0, 5{\%}, 30{\%} respectively, and the medications which had LONAA comprised 48{\%}, 56{\%}, 43{\%}, 62{\%}, 43{\%}, 70{\%} respectively. The medications with HOMAA could be effectively replaced by their LONAA alternatives to ensure safe pharmacotherapy.ConclusionsThe application of the guidelines for prescribing alternatives to anticholinergic medications in this vulnerable population has the potential to reduce untoward effects associated with the prescription of anticholinergic medications, slower cognitive decline, and decrease the risk of mortality. Our next step in this ongoing research will aim at utilizing the interRAI-HC assessments for validating the guidelines in older adults with dementia.",
author = "Sharmin Bala and Hamish Jamieson and Prasad Nishtala and Rhiannon Braund",
note = "SS Bala, HA Jamieson, PS Nishtala, R Braund - Alzheimer's & Dementia: The Journal of the Alzheimer's & Dementia",
year = "2019",
month = "10",
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doi = "10.1016/j.jalz.2019.08.175",
language = "English",
volume = "15",
pages = "P1567--P1568",
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TY - JOUR

T1 - ESTABLISHING GUIDELINES FOR ALTERNATIVES TO ANTICHOLINERGIC MEDICATIONS IN OLDER ADULTS WITH DEMENTIA

AU - Bala, Sharmin

AU - Jamieson, Hamish

AU - Nishtala, Prasad

AU - Braund, Rhiannon

N1 - SS Bala, HA Jamieson, PS Nishtala, R Braund - Alzheimer's & Dementia: The Journal of the Alzheimer's & Dementia

PY - 2019/10/18

Y1 - 2019/10/18

N2 - BackgroundAnticholinergic agents are known to be associated with worsening of cognitive impairment in individuals diagnosed with dementia. With the aid of the international Resident Assessment Instrument-home care (interRAI-HC) tool, we observed a high prevalence of prescribing potentially inappropriate medications in older adults with dementia, especially the anticholinergic class of medications.MethodsBased on the current literature review of the anticholinergic burden scales and serum anticholinergic activity of various medications, we developed a guideline for prescribers, focusing on pharmacological alternatives for the currently prescribed anticholinergic class of medications for older adults with dementia presenting with co-morbidities. The guidelines has been prepared referring to the medications listed in the New Zealand drug formulary. Medications were classified according to the ATC-DDD Index 2019. The health conditions were grouped according to the International Statistical Classification of Diseases and Related Health Problems. Medications were sorted according to the high/moderate anticholinergic activity and their low/no anticholinergic activity substitutes.ResultsWith respect to the medications prescribed for disorders of the central nervous system, of the 117 analysed, 38% were grouped as medications with high or moderate anticholinergic activity (HOMAA), and 56% were found to have low or no anticholinergic activity (LONAA). Similarly, for the gastrointestinal, cardiovascular, respiratory, endocrine, genito-urinary system, and infections; we observed that of all prescribed medications, those which were observed to have HOMAA constituted 28%, 3%, 46%, 0, 5%, 30% respectively, and the medications which had LONAA comprised 48%, 56%, 43%, 62%, 43%, 70% respectively. The medications with HOMAA could be effectively replaced by their LONAA alternatives to ensure safe pharmacotherapy.ConclusionsThe application of the guidelines for prescribing alternatives to anticholinergic medications in this vulnerable population has the potential to reduce untoward effects associated with the prescription of anticholinergic medications, slower cognitive decline, and decrease the risk of mortality. Our next step in this ongoing research will aim at utilizing the interRAI-HC assessments for validating the guidelines in older adults with dementia.

AB - BackgroundAnticholinergic agents are known to be associated with worsening of cognitive impairment in individuals diagnosed with dementia. With the aid of the international Resident Assessment Instrument-home care (interRAI-HC) tool, we observed a high prevalence of prescribing potentially inappropriate medications in older adults with dementia, especially the anticholinergic class of medications.MethodsBased on the current literature review of the anticholinergic burden scales and serum anticholinergic activity of various medications, we developed a guideline for prescribers, focusing on pharmacological alternatives for the currently prescribed anticholinergic class of medications for older adults with dementia presenting with co-morbidities. The guidelines has been prepared referring to the medications listed in the New Zealand drug formulary. Medications were classified according to the ATC-DDD Index 2019. The health conditions were grouped according to the International Statistical Classification of Diseases and Related Health Problems. Medications were sorted according to the high/moderate anticholinergic activity and their low/no anticholinergic activity substitutes.ResultsWith respect to the medications prescribed for disorders of the central nervous system, of the 117 analysed, 38% were grouped as medications with high or moderate anticholinergic activity (HOMAA), and 56% were found to have low or no anticholinergic activity (LONAA). Similarly, for the gastrointestinal, cardiovascular, respiratory, endocrine, genito-urinary system, and infections; we observed that of all prescribed medications, those which were observed to have HOMAA constituted 28%, 3%, 46%, 0, 5%, 30% respectively, and the medications which had LONAA comprised 48%, 56%, 43%, 62%, 43%, 70% respectively. The medications with HOMAA could be effectively replaced by their LONAA alternatives to ensure safe pharmacotherapy.ConclusionsThe application of the guidelines for prescribing alternatives to anticholinergic medications in this vulnerable population has the potential to reduce untoward effects associated with the prescription of anticholinergic medications, slower cognitive decline, and decrease the risk of mortality. Our next step in this ongoing research will aim at utilizing the interRAI-HC assessments for validating the guidelines in older adults with dementia.

U2 - 10.1016/j.jalz.2019.08.175

DO - 10.1016/j.jalz.2019.08.175

M3 - Meeting abstract

VL - 15

SP - P1567-P1568

JO - Alzheimer's & Dementia

JF - Alzheimer's & Dementia

SN - 1552-5260

IS - 7, Supplement

ER -