title: Prevalence and determinants of anticholinergic medication use in elderly dementia patients.
abstract: BACKGROUND
  People with dementia are sensitive to cognitive side effects of anticholinergic drugs. However, little is known about the prevalence of anticholinergic medications and its predictors in a nationally representative sample of community-based elderly dementia patients in the USA.
  
  
  OBJECTIVE
  The objectives of the study were to determine the prevalence and predictors of anticholinergic drugs use in elderly dementia patients.
  
  
  METHODS
  The study involved retrospective analysis of the 2005-2009 Medical Expenditure Panel Surveys (MEPS), a nationally representative sample of the non-institutionalized US population. The study evaluated annual prevalence of anticholinergic drug use during the study period and factors associated with the use of anticholinergics among community-dwelling persons aged 65 and older with dementia. The anticholinergic drugs were identified using the Anticholinergic Drug Scale (ADS). Multiple logistic regression within the conceptual framework of the Anderson Behavioral Model was performed to identify predictors associated with clinically significant anticholinergic drug (ADS level 2 or 3) use.
  
  
  RESULTS
  According to the MEPS, there were a total of 1.56 [95 % confidence interval (CI) 1.34, 1.73] million elderly dementia patients annually during the study period. Approximately, 23.3 % (95 % CI 19.2, 27.5) of elderly dementia patients used clinically significant anticholinergic agents (ADS level 2 or 3). Among the need factors, elderly dementia patients having mood disorders [odds ratio (OR) 2.19; 95 % CI 1.19, 4.06] and urinary incontinence (OR 6.58; 95 % CI 2.84, 15.29) were more likely to use drugs with clinically significant anticholinergic activities. Of the enabling factors, the odds of receiving higher-level anticholinergic drugs were significantly lower for patients who resided in the West region (OR 0.41; 95 % CI 0.17, 0.95) compared to the reference group, Northeast.
  
  
  CONCLUSIONS
  Over one in five elderly dementia patients used drugs with clinically significant anticholinergic effects. Mood disorder, urinary incontinence, and region were significantly associated with use of these drugs. Concerted efforts are needed to improve the quality of medication use by focusing on clinically significant anticholinergic agents.
authors.affiliation: Department of Clinical Sciences and Administration, College of Pharmacy, Texas Medical Center, University of Houston, 1441 Moursund Street, Houston, TX, 77030, USA.
authors.forename: Sneha D
authors.initials: SD
authors.lastname: Sura
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Carnahan
authors.forename: Hua
authors.initials: H
authors.lastname: Chen
authors.forename: Rajender R
authors.initials: RR
authors.lastname: Aparasu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D003625:Data Collection; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D018680:Cholinergic Antagonists