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Anticholinergic Burden and Most Common Anticholinergic-acting Medicines in Older General Practice Patients



Anticholinergic Burden and Most Common Anticholinergic-acting Medicines in Older General Practice Patients



Zdravstveno Varstvo 57(3): 140-147



Anticholinergic burden in older adults has been correlated with cognitive decline, delirium, dizziness and confusion, falls and hospitalisations. Nevertheless, anticholinergic-acting medications remain commonly prescribed in up to a third of older adults in primary care population. Our aim was to study the anticholinergic burden in older adults in Slovenian ambulatory setting and explore the most commonly involved medications which could be avoided by the physicians. A cross-sectional study was conducted in 30 general practices in Slovenia as part of a larger trial. Data on prescribed medications were collected for randomly chosen adults of over 65 years of age visiting general practice, who were taking at least one regularly prescribed medication. Anticholinergic burden was calculated using Duran's scale and Drug Burden Index. Altogether, 622 patients were included, 356 (57.2%) female, average age of 77.2 (±6.2), with an average of 5.6 medications. At least one anticholinergic medication was present in 78 (12.5 %) patients. More than half (N=41, 52.6%) of anticholinergic prescriptions were psychotropic medications. Most common individual medications were diazepam (N=10, 1.6%), quetiapine (N=9, 1.4%) and ranitidine (N=8, 1.3%). Though the prevalence of anticholinergic medications was low compared to international research, the most commonly registered anticholinergic prescriptions were medications that should be avoided according to guidelines of elderly prescriptions. It would be probably clinically feasible to further decrease the anticholinergic burden of older adults in Slovenian primary care setting by avoiding or replacing these medications with safer alternatives. Večje antiholinergično breme pri starejših odraslih je povezano s kognitivnim upadom, delirijem, zmedenostjo, padci in hospitalizacijami. Kljub temu ima predpisane antiholinergike skoraj tretjina starostnikov na primarnem nivoju. Želeli smo raziskati antiholinergično breme pri starostnikih v ambulantah družinske medicine v Sloveniji in najpogostejša zdravila z antiholinergicnim delovanjem, ki bi se jim zdravniki pri predpisovanju lahko izognili. V presečni raziskavi smo v 30 ambulantah družinske medicine zbrali podatke o predpisanih zdravilih za naključno izbrane starostnike nad 65 let, ki so na dan raziskave zaradi kateregakoli razloga obiskali ambulanto in ki so kot redno terapijo jemali vsaj eno zdravilo. Antiholinergicno breme smo izračunali s pomocjo Duranove lestvice in lestvice Drug Burden Index. V raziskavo je bilo vključenih skupno 622 bolnikov, od tega 356 (57,2 %) žensk. Povprecna starost je bila 77,2 (± 6,2) leta, bolniki pa so jemali povprečno 5,6 zdravila. Vsaj eno antiholinergično zdravilo je jemalo 78 (12,5 %) bolnikov. Več kot polovica (N = 41, 52,6 %) vseh predpisnih zdravil z antiholinergičnimi učinki je bila psihotropnih. Med posameznimi zdravili so bili najpogosteje predpisani diazepam (N = 10, 1,6 %), kvetiapin (N = 9, 1,4 %) in ranitidin (N = 8, 1,3 %). Prevalenca predpisovanja antiholinergičnih zdravil je bila nizka v primerjavi z mednarodnimi raziskavami, vendar pa so bila antiholinergična zdravila med najpogosteje predpisanimi zdravili, ki jih smernice o predpisovanju zdravil pri starostnikih odsvetujejo. Verjetno bi bilo mogoče še dodatno zmanjšati antiholinergično breme pri starostnikih na primarnem nivoju v Sloveniji s tem, da bi se tem zdravilom izognili ali jih zamenjali z varnejšimi alternativami.

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Accession: 048270500

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PMID: 29983780


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