title: Use of drugs with anticholinergic properties among nursing home residents with dementia: a national analysis of Medicare beneficiaries from 2007 to 2008.
abstract: BACKGROUND
  Older adults with dementia are vulnerable to the central deteriorating effects of drugs with anticholinergic properties (DAPs). These effects include falls and confusion and may exacerbate dementia-related symptoms. Many individuals with dementia also receive acetylcholinesterase inhibitors (AChEIs), indicated for mild to moderate Alzheimer's disease. AChEIs have opposing effects to DAPs and, consequently, concomitant use of DAPs and AChEIs may further impair cognition among patients with dementia.
  
  
  OBJECTIVE
  Our objectives were to (1) evaluate the anticholinergic burden among nursing home (NH) residents with dementia; (2) characterize trends in use of DAPs and concomitant use of DAPs and AChEIs among NH residents with dementia; and (3) identify factors associated with the use of DAPs and concomitant use of DAPs and AChEIs.
  
  
  METHODS
  We conducted a retrospective analysis of Medicare data from 2007 to 2008 linked to the Minimum Data Set.
  
  
  RESULTS
  During the study period, 53,805 (77%) NH residents with dementia used at least one DAP each month. Sixty-seven percent of residents with dementia used Anticholinergic Cognitive Burden Scale (ACBS) level 1 DAPs, 3% used level 2 DAPs, and 31% used level 3 DAPs. Thirteen percent of NH residents with dementia concomitantly used ACBS levels 2 or 3 DAPs and AChEIs.
  
  
  CONCLUSIONS
  This study sheds new light on the prevalence of DAP use and concomitant use of DAPs and AChEIs among NH residents with dementia. Clinicians should consider alternatives with lower anticholinergic effects, particularly in patients already taking DAPs.
authors.affiliation: Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA.
authors.forename: Jacqueline B
authors.initials: JB
authors.lastname: Palmer
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Albrecht
authors.forename: Yujin
authors.initials: Y
authors.lastname: Park
authors.forename: Sarah
authors.initials: S
authors.lastname: Dutcher
authors.forename: Gail B
authors.initials: GB
authors.lastname: Rattinger
authors.forename: Linda
authors.initials: L
authors.lastname: Simoni-Wastila
authors.forename: Loreen D
authors.initials: LD
authors.lastname: Walker
authors.forename: Ilene H
authors.initials: IH
authors.lastname: Zuckerman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D018680:Cholinergic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D009735:Nursing Homes; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States
chemical_list: D018680:Cholinergic Antagonists; D002800:Cholinesterase Inhibitors