title: Ten-year trajectory of potentially inappropriate medications in very old women: importance of cognitive status.
abstract: OBJECTIVE
  To determine which older adults tend to receive potentially inappropriate medications (PIMs), how this may differ according to cognitive status, and how the trajectories of PIM use change over time.
  
  
  METHODS
  Ten-year longitudinal cohort study.
  
  
  METHODS
  Three clinical sites in the United States.
  
  
  METHODS
  One thousand four hundred eighty-four community-dwelling women aged 75 and older.
  
  
  METHODS
  At follow-up, cognitive status was ascertained and classified as normal, mild cognitive impairment (MCI), or dementia. Beers 2003 criteria and other literature were used to identify PIMs from detailed medication inventory performed at three time points. Anticholinergic load was measured using the Anticholinergic Cognitive Burden Scale (ACB), which assigns medications a value from 0 to 3 depending on anticholinergic properties.
  
  
  RESULTS
  At baseline, 23.9% of women were taking at least one PIM and the mean ± SD ACB score was 1.41 ± 1.69. The most frequently reported PIMs were anticholinergics (15.2%), benzodiazepines (8.6%), and antispasmodics (8.0%). Over 10 years, PIM use increased for women with dementia (24.9-33.1%; P = .02) but remained fairly constant for women with MCI (23.9-23.0%; P = .84) and normal cognitive status (22.2-19.8%; P = .17). Mean ACB score increased significantly (P < .001) over time for all groups (dementia: 1.28-2.05; MCI: 0.98-1.66; normal: 0.99-1.48).
  
  
  CONCLUSIONS
  PIM use and anticholinergic load in a community-dwelling population of older women was high, especially in women who later developed dementia. Future guidelines should limit PIM use and seek safer alternatives.
authors: Northern California Institute for Research and Education, San Francisco, California, USA. alain.koyama@va.gov
authors: Alain
authors: A
authors: Koyama
authors: Michael
authors: M
authors: Steinman
authors: Kristine
authors: K
authors: Ensrud
authors: Teresa A
authors: TA
authors: Hillier
authors: Kristine
authors: K
authors: Yaffe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000188:drug therapy*; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008508:Medication Errors / Q000639:trends*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States