title: Potentially inappropriate anticholinergic medication use in community-dwelling older adults: a national cross-sectional study.
abstract: BACKGROUND
  Inappropriate medications are often used in older adults despite their unfavourable risk-to-benefit profile. Although many of the medications in the American Geriatrics Society (AGS) Beers list are potentially inappropriate because of their anticholinergic properties, little is known regarding the nature and extent of potentially inappropriate anticholinergic medication use in older adults.
  
  
  OBJECTIVE
  To determine the prevalence of, and factors associated with, potentially inappropriate anticholinergic medication use in the older population.
  
  
  METHODS
  A retrospective, cross-sectional study was conducted, involving older adults (aged 65 years and older), using 2009-2010 Medical Expenditure Panel Survey (MEPS) data. The 2012 AGS Beers Criteria were used to define potentially inappropriate anticholinergic medications on the basis of the list of medications to avoid using in older adults irrespective of the diagnosis. Descriptive analyses were used to examine the nature and extent of potentially inappropriate anticholinergic medication use. Multivariable logistic regression within the conceptual framework of the Andersen Behavioral Model was used to identify the factors associated with potentially inappropriate anticholinergic use in older adults.
  
  
  RESULTS
  According to the MEPS, there were 78.60 million older adults in the USA; an estimated 7.51 million (9.56 %) of these older adults used potentially inappropriate anticholinergic medications in 2009-2010. The most frequently used potentially inappropriate anticholinergics were cyclobenzaprine, promethazine, amitriptyline, hydroxyzine and dicyclomine. Multivariable regression analyses revealed that female sex, residing in the South and the presence of anxiety disorder increased the likelihood of receiving potentially inappropriate anticholinergic medications, whereas older adults aged 75-84 or ≥ 85 years, and those with over 15 years of education, had a decreased likelihood of receiving potentially inappropriate anticholinergic medications.
  
  
  CONCLUSIONS
  The study found that approximately one in ten older adults used potentially inappropriate anticholinergic medications. Several predisposing, enabling and need factors were associated with the use of potentially inappropriate anticholinergic medications. Concerted efforts are needed to optimize potentially inappropriate anticholinergic medication use in older adults.
authors.affiliation: Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, 1441 Moursund Street, Houston, TX, 77030, USA.
authors.forename: Nandita
authors.initials: N
authors.lastname: Kachru
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Carnahan
authors.forename: Michael L
authors.initials: ML
authors.lastname: Johnson
authors.forename: Rajender R
authors.initials: RR
authors.lastname: Aparasu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001519:Behavior / Q000187:drug effects; D018680:Cholinergic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005843:Geography; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D015233:Models, Statistical; D015995:Prevalence; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D018680:Cholinergic Antagonists
references.citation: Am J Psychiatry. 1992 Oct;149(10):1393-4
references.pmid: 1530077
references.citation: J Am Geriatr Soc. 2004 Dec;52(12):2082-7
references.pmid: 15571547
references.citation: J Clin Pharmacol. 2011 Feb;51(2):256-63
references.pmid: 20489026
references.citation: Med Care. 2007 May;45(5):472-6
references.pmid: 17446834
references.citation: Am J Geriatr Pharmacother. 2011 Dec;9(6):434-41
references.pmid: 22030114
references.citation: Scand J Prim Health Care. 2007 Mar;25(1):9-14
references.pmid: 17354153
references.citation: Ann Pharmacother. 2010 Jul-Aug;44(7-8):1171-80
references.pmid: 20587746
references.citation: Arch Intern Med. 1991 Sep;151(9):1825-32
references.pmid: 1888249
references.citation: Drugs Aging. 2000 Jun;16(6):437-50
references.pmid: 10939308
references.citation: J Health Soc Behav. 1995 Mar;36(1):1-10
references.pmid: 7738325
references.citation: Pharmacotherapy. 2000 Feb;20(2):221-8
references.pmid: 10678301
references.citation: Arch Intern Med. 2003 Dec 8-22;163(22):2716-24
references.pmid: 14662625
references.citation: N Engl J Med. 2010 Nov 18;363(21):1985-8
references.pmid: 21047217
references.citation: Psychopharmacology (Berl). 2011 Feb;213(2-3):441-52
references.pmid: 19823805
references.citation: Am J Med. 2009 Dec;122(12):1142-1149.e1-2
references.pmid: 19958893
references.citation: Ann Intern Med. 1992 Oct 15;117(8):684-9
references.pmid: 1308759
references.citation: J Am Geriatr Soc. 1990 May;38(5):542-52
references.pmid: 2185295
references.citation: J Clin Psychiatry. 2002 Nov;63(11):1020-7
references.pmid: 12444816
references.citation: Health Serv Res. 2004 Oct;39(5):1257-76
references.pmid: 15333108
references.citation: Drugs Aging. 2010 Dec 1;27(12):987-97
references.pmid: 21087068
references.citation: Arch Intern Med. 1997 Jul 28;157(14):1531-6
references.pmid: 9236554
references.citation: Arch Intern Med. 1994 Oct 10;154(19):2195-200
references.pmid: 7944840
references.citation: Milbank Mem Fund Q Health Soc. 1973 Winter;51(1):95-124
references.pmid: 4198894
references.citation: Arch Intern Med. 2004 Aug 9-23;164(15):1621-5
references.pmid: 15302631
references.citation: Pharmacoepidemiol Drug Saf. 2012 Feb;21(2):170-6
references.pmid: 21671440
references.citation: J Am Geriatr Soc. 2004 Nov;52(11):1847-55
references.pmid: 15507061
references.citation: Ann Pharmacother. 2013 Jul-Aug;47(7-8):993-8
references.pmid: 23821610
references.citation: Ann Pharmacother. 2005 Mar;39(3):405-11
references.pmid: 15671088
references.citation: J Am Geriatr Soc. 2012 Apr;60(4):616-31
references.pmid: 22376048
references.citation: J Gen Intern Med. 2013 Apr;28(4):546-53
references.pmid: 23129159
references.citation: Eur Arch Psychiatry Clin Neurosci. 2010 Nov;260 Suppl 2:S111-5
references.pmid: 20960005
references.citation: J Am Geriatr Soc. 2011 Aug;59(8):1477-83
references.pmid: 21707557
references.citation: J Am Pharm Assoc (Wash). 2002 Nov-Dec;42(6):847-57
references.pmid: 12482007
references.citation: Ann Pharmacother. 1997 Jul-Aug;31(7-8):823-9
references.pmid: 9220038
references.citation: JAMA. 1994 Jul 27;272(4):292-6
references.pmid: 8028142
references.citation: Age Ageing. 2014 Sep;43(5):604-15
references.pmid: 25038833
references.citation: J R Soc Med. 2000 Sep;93(9):457-62
references.pmid: 11089480
references.citation: Med Care. 2009 Jul;47(7 Suppl 1):S44-50
references.pmid: 19536015
references.citation: J Am Med Dir Assoc. 2009 May;10(4):252-7
references.pmid: 19426941
references.citation: Drugs Aging. 2013 Oct;30(10):837-44
references.pmid: 23881698