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Anticholinergic burden: considerations for older adults

Authors

  • Lisa Kouladjian O'Donnell MPharm, PhD,

    Corresponding author
    1. NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, Australia
    2. Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, Australia
    • Address for correspondence: Lisa Kouladjian O'Donnell, Departments of Clinical Pharmacology and Aged Care, Level 12 Kolling Building, Royal North Shore Hospital, Reserve Road, St Leonards, New South Wales 2065, Australia

      E-mail: lisa.kouladjian@sydney.edu.au

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  • Danijela Gnjidic MPH, PhD,

    1. Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, Australia
    2. Faculty of Pharmacy, University of Sydney, Sydney, Australia
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  • Rayan Nahas BPharm (Hons), GradCertPharmPrac,

    1. Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, Australia
    2. Pharmacy Department, Royal North Shore Hospital, St Leonards, Australia
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  • J. Simon Bell BPharm (Hons), PhD,

    1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
    2. NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia
    3. Department of Epidemiology and Preventive Medicine, Faculty of Nursing, Medicine and Health Sciences, Monash University, Melbourne, Australia
    4. Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
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  • Sarah N. Hilmer MBBS, PhD

    1. NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, Australia
    2. Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, Australia
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Abstract

Anticholinergic medications are frequently used in older adults to manage a wide range of chronic diseases. Anticholinergic burden associated with the use of multiple medications with anticholinergic effects is cumulative within an individual, and older adults are particularly susceptible to the adverse effects of these medications. These include dry mouth resulting in poor oral health, constipation, urinary retention and confusion. Use of anticholinergic medications has been associated with impaired cognitive and physical function, increased risk of falls, vascular events and hospitalisation. Consideration of anticholinergic burden is an important component of medication management for older adults. Several measures have been developed and validated to quantify anticholinergic burden, such as the Anticholinergic Drug Scale, Anticholinergic Risk Scale and the Anticholinergic Cognitive Burden scale. However, the evidence for translation of these measures into clinical practice is limited. This narrative review provides a brief clinical overview of the pharmacology of anticholinergic medications in the context of older adults, summarises approaches to measure anticholinergic burden, reviews recent evidence of the clinical impact of anticholinergic medications and discusses deprescribing strategies to manage anticholinergic burden for older adults in clinical practice.

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