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International Journal of Clinical Pharmacy

, Volume 41, Issue 5, pp 1152–1158 | Cite as

Anticholinergic and sedative medications exposure in older patients: a cross-sectional study

  • Xiaolin Zhang
  • Shuang Zhou
  • Xinran Li
  • Weiwei Zhou
  • Ying Zhou
  • Yimin Cui
  • Xinmin LiuEmail author
Research Article

Abstract

Background The Drug Burden Index is a risk assessment tool used to quantify anticholinergic and sedative medications burden of older patients. There have been no previously published reports the exposure of anticholinergic and sedative medications in China. Objective We investigated the prevalence and correlates risk factors of anticholinergic and sedative medications in hospitalized older patients with polypharmacy in China. Settings The Department of Geriatrics in a tertiary care teaching hospital. Methods A retrospective analysis of patient medical records of hospitalized older patients with polypharmacy was undertaken at a large university teaching hospital in China. Polypharmacy was defined as the regular use of more than five medications. Prescribing of anticholinergic and sedative medications was identified using the medication list of the Drug Burden Index, and logistic regression analysis determined associations between drug exposure and independent variables. Main outcome measure Anticholinergic and sedative medications identified by the Drug Burden Index. Results A total of 383 patients were included in this study, with an average age of 82.6 ± 7.0 years and included 72.9% (279/383) male patients. Of the study participants, 23.8% (91/383) were prescribed anticholinergic and sedative medications. Of the 106 medicines identified by the Drug Burden Index, the most frequently prescribed medications were estazolam in 51.9% (55/106), terazosin in 14.1% (15/106), loratadine in 10.4% (11/106), and cetirizine in 5.7% (6/106); these four medications accounted for 82.1% of the anticholinergic and sedative medications. Drug exposure was associated with age ≥ 80 years (OR 2.246; 95% CI 1.100–4.586), the number of prescribed medications (OR 1.102; 95% CI 1.018–1.193), and symptoms of insomnia (OR 28.990; 95% CI 14.197–59.200). Conclusions The findings of this study showed that the prevalence of anticholinergic and sedative exposure in hospitalized older patients with polypharmacy in China. The prevalence of exposure of anticholinergic and sedative medications was 23.8%. According to the Drug Burden Index estazolam and terazosin were the most common medications in the sedative or anticholinergic drug class, respectively.

Keywords

Anticholinergic effects China Drug Burden Index Polypharmacy Sedatives 

Notes

Acknowledgements

We thank the staff members of department of geriatrics and pharmacy in Peking University First Hospital for their assistance with the administration of this study.

Funding

Financial support for this work was received from the Scientific Research Seed Fund of Peking University First Hospital (2018SF058).

Conflicts of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57–65.CrossRefGoogle Scholar
  2. 2.
    Alwhaibi M, Balkhi B, Alhawassi TM, Alkofide H, Alduhaim N, Alabdulali R, et al. Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open. 2018;8(5):e020852.CrossRefGoogle Scholar
  3. 3.
    Nishtala PS, Hilmer SN, McLachlan AJ, Hannan PJ, Chen TF. Impact of residential medication management reviews on Drug Burden Index in aged-care homes: a retrospective analysis. Drugs Aging. 2009;26(8):677–86.CrossRefGoogle Scholar
  4. 4.
    Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169.CrossRefGoogle Scholar
  5. 5.
    Rothberg MB, Herzig SJ, Pekow PS, Avrunin J, Lagu T, Lindenauer PK. Association between sedating medications and delirium in older inpatients. J Am Geriatr Soc. 2013;61(6):923–30.CrossRefGoogle Scholar
  6. 6.
    Rolita L, Spegman A, Tang X, Cronstein BN. Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults. J Am Geriatr Soc. 2013;61(3):335–40.CrossRefGoogle Scholar
  7. 7.
    Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A Drug Burden Index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781–7.CrossRefGoogle Scholar
  8. 8.
    Wouters H, van der Meer H, Taxis K. Quantification of anticholinergic and sedative drug load with the Drug Burden Index: a review of outcomes and methodological quality of studies. Eur J Clin Pharmacol. 2017;73(3):257–66.CrossRefGoogle Scholar
  9. 9.
    Jamieson HA, Nishtala PS, Scrase R, Deely JM, Abey-Nesbit R, Connolly MJ, et al. Drug burden and its association with falls among older adults in New Zealand: a national population cross-sectional study. Drugs Aging. 2018;35(1):73–81.CrossRefGoogle Scholar
  10. 10.
    Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10(2):61–3.CrossRefGoogle Scholar
  11. 11.
    Charlson M, Pompei P, Ales K, MacKenzie C. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefGoogle Scholar
  12. 12.
    Best O, Gnjidic D, Hilmer SN, Naganathan V, McLachlan AJ. Investigating polypharmacy and Drug Burden Index in hospitalised older people. Intern Med J. 2013;43(8):912–8.CrossRefGoogle Scholar
  13. 13.
    Kouladjian L, Gnjidic D, Chen TF, Mangoni AA, Hilmer SN. Drug Burden Index in older adults: theoretical and practical issues. Clin Interv Aging. 2014;9:1503–15.CrossRefGoogle Scholar
  14. 14.
    Harrison SL, Kouladjian O’Donnell L, Bradley CE, Milte R, Dyer SM, Gnanamanickam ES, et al. Associations between the Drug Burden Index, potentially inappropriate medications and quality of life in residential aged care. Drugs Aging. 2018;35(1):83–91.CrossRefGoogle Scholar
  15. 15.
    Zhang X, Zhou S, Pan K, Li X, Zhao X, Zhou Y, et al. Potentially inappropriate medications in hospitalized older patients: a cross-sectional study using the Beers 2015 criteria versus the 2012 criteria. Clin Interv Aging. 2017;12:1697–703.CrossRefGoogle Scholar
  16. 16.
    Mo L, Ding D, Pu SY, Liu QH, Li H, Dong BR, et al. Patients aged 80 years or older are encountered more potentially inappropriate medication use. Chin Med J. 2016;129(1):22–7.CrossRefGoogle Scholar
  17. 17.
    Miner B, Gill TM, Yaggi HK, Redeker NS, Van Ness PH, Han L, et al. Insomnia in community-living persons with advanced age. J Am Geriatr Soc. 2018;66:1592–7.CrossRefGoogle Scholar
  18. 18.
    Hanlon JT, Semla TP, Schmader KE. Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug–disease interactions in the elderly quality measures. J Am Geriatr Soc. 2015;63(12):e8–18.CrossRefGoogle Scholar
  19. 19.
    Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890–8.CrossRefGoogle Scholar
  20. 20.
    Westbury JL, Gee P, Ling T, Brown DT, Franks KH, Bindoff I, et al. RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities. Med J Aust. 2018;208(9):398–403.CrossRefGoogle Scholar
  21. 21.
    Oelke M, Gericke A, Michel MC. Cardiovascular and ocular safety of alpha1-adrenoceptor antagonists in the treatment of male lower urinary tract symptoms. Expert Opin Drug Saf. 2014;13(9):1187–97.CrossRefGoogle Scholar
  22. 22.
    American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015;63(11):2227–46.Google Scholar
  23. 23.
    Cancelli I, Beltrame M, Gigli GL, Valente M. Drugs with anticholinergic properties: cognitive and neuropsychiatric side-effects in elderly patients. Neurol Sci. 2009;30(2):87–92.CrossRefGoogle Scholar
  24. 24.
    Hasler S, Senn O, Rosemann T, Neuner-Jehle S. Effect of a patient-centered drug review on polypharmacy in primary care patients: study protocol for a cluster-randomized controlled trial. Trials. 2015;16:380.CrossRefGoogle Scholar
  25. 25.
    van der Cammen TJ, Rajkumar C, Onder G, Sterke CS, Petrovic M. Drug cessation in complex older adults: time for action. Age Ageing. 2014;43(1):20–5.CrossRefGoogle Scholar
  26. 26.
    Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010;58(4):681–7.CrossRefGoogle Scholar
  27. 27.
    O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Xiaolin Zhang
    • 1
  • Shuang Zhou
    • 2
  • Xinran Li
    • 2
  • Weiwei Zhou
    • 1
  • Ying Zhou
    • 2
  • Yimin Cui
    • 2
  • Xinmin Liu
    • 1
    Email author
  1. 1.Department of GeriatricsPeking University First HospitalBeijingPeople’s Republic of China
  2. 2.Department of PharmacyPeking University First HospitalBeijingPeople’s Republic of China

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