Prevalence of strong anticholinergic use in residents with and without cognitive impairment and frailty: Analysis from 106 nursing homes in 12 Asia-Pacific and European countries

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dc.contributor.authorCross, A.J.
dc.contributor.authorVillani, E.R.
dc.contributor.authorJadczak, A.D.
dc.contributor.authorPitkälä, K.
dc.contributor.authorHamada, S.
dc.contributor.authorZhao, M.
dc.contributor.authorGutiérrez-Valencia, M.
dc.contributor.authorAalto, U.
dc.contributor.authorDowd, L.A.
dc.contributor.authorLi, L.
dc.contributor.authorLiau, S.J.
dc.contributor.authorLiperoti, R.
dc.contributor.authorMartínez-Velilla, N.
dc.contributor.authorOoi, C.E.
dc.contributor.authorOnder, G.
dc.contributor.authorPetrie, K.
dc.contributor.authorRoitto, H.M.
dc.contributor.authorRoncal-Belzunce, V.
dc.contributor.authorSaarela, R.
dc.contributor.authorSakata, N.
dc.contributor.authoret al.
dc.date.issued2025
dc.description.abstractPURPOSE: There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty. METHODS: Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0-2 (non-frail), 3-6 (frail) and 7-14 (most-frail). Data were analyzed using descriptive statistics. RESULTS: Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %). CONCLUSIONS: One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.
dc.description.statementofresponsibilityAmanda J. Cross, Emanuele R. Villani, Agathe D. Jadczak, Kaisu Pitkal, Shota Hamada, Meng Zhao, Marta Guti, errez-Valencia, Ulla Aalto m, Laura A. Dowd, Li Li, Shin J. Liau, Rosa Liperoti, Nicol, as Martínez-Velilla, Choon Ean Ooi, Graziano Onder, Kate Petrie, Hanna M. Roitto, Victoria Roncal-Belzunce, Riitta Saarela, Nobuo Sakata, Renuka Visvanathan, Tiange G. Zhang, J. Simon Bell
dc.identifier.citationArchives of Gerontology and Geriatrics, 2025; 128:105636-1-105636-11
dc.identifier.doi10.1016/j.archger.2024.105636
dc.identifier.issn0167-4943
dc.identifier.issn1872-6976
dc.identifier.orcidJadczak, A.D. [0000-0002-7501-7996]
dc.identifier.orcidVisvanathan, R. [0000-0002-1303-9479]
dc.identifier.urihttps://hdl.handle.net/2440/144279
dc.language.isoen
dc.publisherElsevier BV
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/2009633
dc.rights© 2024 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
dc.source.urihttp://dx.doi.org/10.1016/j.archger.2024.105636
dc.subjectAnticholinergic
dc.subjectCognitive impairment
dc.subjectDementia
dc.subjectFrailty
dc.subjectLong-term care
dc.subjectNursing homes
dc.subject.meshHumans
dc.subject.meshDementia
dc.subject.meshCholinergic Antagonists
dc.subject.meshPrevalence
dc.subject.meshCross-Sectional Studies
dc.subject.meshAged
dc.subject.meshAged, 80 and over
dc.subject.meshFrail Elderly
dc.subject.meshHomes for the Aged
dc.subject.meshNursing Homes
dc.subject.meshAsia
dc.subject.meshEurope
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshCognitive Dysfunction
dc.subject.meshFrailty
dc.titlePrevalence of strong anticholinergic use in residents with and without cognitive impairment and frailty: Analysis from 106 nursing homes in 12 Asia-Pacific and European countries
dc.typeJournal article
pubs.publication-statusPublished

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