title: Anticholinergic burden in older women: not seeing the wood for the trees?
abstract: OBJECTIVE
  To identify medicines contributing to and describe predictors of anticholinergic burden among community-dwelling older Australian women.
  
  
  METHODS
  Retrospective longitudinal analysis of data from the Australian Longitudinal Study on Women's Health linked to Pharmaceutical Benefits Scheme medicines data from 1 January 2008 to 30 December 2010; for 3694 women born in 1921-1926.
  
  
  METHODS
  Anticholinergic burden calculated from Anticholinergic Drug Scale (ADS) scores derived from ADS levels (0 to 3) for all medicines used by each woman, summed over each 6-month period (semester), medicines commonly used by women with high semester ADS scores (defined as 75th percentile of scores).
  
  
  RESULTS
  1126 women (59.9%) used at least one medicine with anticholinergic properties. The median ADS score was 4 or 5 across all semesters. Most anticholinergic medicines used by women who had a high anticholinergic burden (ADS score, ≥ 9) had a low anticholinergic potency (ADS level 1). Increasing age, cardiovascular disease, and number of other medicines used were predictive of a higher anticholinergic burden.
  
  
  CONCLUSIONS
  A high anticholinergic medicines burden in this group was driven by the use of multiple medicines with lower anticholinergic potency rather than the use of medicines with higher potency. This is a novel and important finding for clinical practice as doctors would readily identify the risk of a high anticholinergic burden for patients using high potency medicines, but may be less likely to identify this risk for users of multiple medicines with low anticholinergic potency.
authors: Central Queensland University, North Rockhampton, QLD, Australia. l.parkinson@cqu.edu.au.
authors: Lynne
authors: L
authors: Parkinson
authors: University of Newcastle, Newcastle, NSW, Australia.
authors: Parker J
authors: PJ
authors: Magin
authors: General Practice Training Valley to Coast, Newcastle, NSW, Australia.
authors: Allison
authors: A
authors: Thomson
authors: University of Newcastle, Newcastle, NSW, Australia.
authors: Julie E
authors: JE
authors: Byles
authors: Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.
authors: Gillian E
authors: GE
authors: Caughey
authors: University of Western Australia, Perth, WA, Australia.
authors: Christopher
authors: C
authors: Etherton-Beer
authors: The University of Sydney, Sydney, NSW, Australia.
authors: Danijela
authors: D
authors: Gnjidic
authors: The University of Sydney, Sydney, NSW, Australia.
authors: Sarah N
authors: SN
authors: Hilmer
authors: University of Newcastle, Newcastle, NSW, Australia.
authors: Thomas King Tong
authors: TK
authors: Lo
authors: University of Glasgow, Glasgow, United Kingdom.
authors: Colin
authors: C
authors: McCowan
authors: Curtin University, Perth, WA, Australia.
authors: Rachael
authors: R
authors: Moorin
authors: University of Newcastle, Newcastle, NSW, Australia.
authors: C Dimity
authors: CD
authors: Pond
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D017281:Cost of Illness; D004357:Drug Synergism; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D012189:Retrospective Studies
chemical_list: D018680:Cholinergic Antagonists