Anticholinergic burden in older women: not seeing the wood for the trees?
Date
2015
Authors
Parkinson, L.
Magin, P.
Thomson, A.
Byles, J.
Caughey, G.
Etherton-Beer, C.
Gnjidic, D.
Hilmer, S.
Lo, T.
McCowan, C.
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Journal article
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Medical Journal of Australia, 2015; 202(2):91-95
Statement of Responsibility
Lynne Parkinson, Parker J Magin, Allison Thomson, Julie E Byles, Gillian E Caughey, Christopher Etherton-Beer, Danijela Gnjidic, Sarah N Hilmer, Thomas King Tong Lo, Colin McCowan, Rachael Moorin, C Dimity Pond
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Abstract
OBJECTIVES: To identify medicines contributing to and describe predictors of anticholinergic burden among community-dwelling older Australian women. DESIGN, SETTING AND PARTICIPANTS: Retrospective longitudinal analysis of data from the Australian Longitudinal Study on Women's Health linked to Pharmaceutical Benefits Scheme medicines data from 1 January 2008 to 30 December 2010; for 3694 women born in 1921-1926. MAIN OUTCOME MEASURES: Anticholinergic burden calculated from Anticholinergic Drug Scale (ADS) scores derived from ADS levels (0 to 3) for all medicines used by each woman, summed over each 6-month period (semester), medicines commonly used by women with high semester ADS scores (defined as 75th percentile of scores). RESULTS: 1126 women (59.9%) used at least one medicine with anticholinergic properties. The median ADS score was 4 or 5 across all semesters. Most anticholinergic medicines used by women who had a high anticholinergic burden (ADS score, ≥ 9) had a low anticholinergic potency (ADS level 1). Increasing age, cardiovascular disease, and number of other medicines used were predictive of a higher anticholinergic burden. CONCLUSIONS: A high anticholinergic medicines burden in this group was driven by the use of multiple medicines with lower anticholinergic potency rather than the use of medicines with higher potency. This is a novel and important finding for clinical practice as doctors would readily identify the risk of a high anticholinergic burden for patients using high potency medicines, but may be less likely to identify this risk for users of multiple medicines with low anticholinergic potency.
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