title: Use of anticholinergic drugs and cholinesterase inhibitors and their association with psychological well-being among frail older adults in residential care facilities.
abstract: BACKGROUND
  Drugs with anticholinergic properties have harmful effects among frail older people and they may antagonize the effects of cholinesterase inhibitors (ChEIs). However, their association with psychological well-being has not been studied.
  
  
  OBJECTIVE
  To determine (1) the prevalence of the use of anticholinergic drugs, ChEIs, or their combination among older adults in residential care facilities and their association with psychological well-being, and (2) the association of anticholinergic drugs with an individual's psychological well-being.
  
  
  METHODS
  In 2007, all older adults (N = 1475) living in residential care facilities in the cities of Helsinki and Espoo, Finland, were assessed in a cross-sectional study. A trained nurse retrieved data on demographic factors, regularly administered medications, and diagnoses from medical charts. Psychological well-being was assessed using 6 questions concerning life satisfaction, zest for life, plans for the future, feeling needed, and feeling depressed or lonely, and a psychological well-being score was created (range 0-1).
  
  
  RESULTS
  Residents taking anticholinergic drugs (n = 613) were significantly younger, used more drugs, and were more often on ChEIs compared with nonusers (n = 862). There was no significant difference in Charlson comorbidity index, stage of cognition, or dependence on activities of daily living between the users or nonusers of anticholinergic drugs. The anticholinergic drug users had significantly lower psychological well-being scores compared with the nonusers. Of the participants, 10.7% used ChEIs and anticholinergic drugs concomitantly. In logistic regression analysis where age, sex, comorbidities, and use of ChEIs were used as covariates, lower psychological well-being was associated with the use of anticholinergic drugs (OR 1.40; 95% CI 1.00 to 1.94; p = 0.048).
  
  
  CONCLUSIONS
  Concomitant use of anticholinergic drugs and ChEIs is common among older adults. The use of anticholinergic drugs is associated with poor psychological well-being.
authors.affiliation: Home Nursing Services, Helsinki City Health Center, Helsinki, Finland.
authors.forename: Mariko
authors.initials: M
authors.lastname: Teramura-Grönblad
authors.forename: Seija
authors.initials: S
authors.lastname: Muurinen
authors.forename: Helena
authors.initials: H
authors.lastname: Soini
authors.forename: Merja
authors.initials: M
authors.lastname: Suominen
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkälä
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003858:Dependency, Psychological; D003863:Depression / Q000517:prevention & control; D004347:Drug Interactions; D005260:Female; D005387:Finland; D016330:Frail Elderly; D006801:Humans; D008297:Male; D010549:Personal Satisfaction; D011581:Psychological Tests; D012112:Residential Facilities
chemical_list: D018680:Cholinergic Antagonists; D002800:Cholinesterase Inhibitors