Anticholinergic Drugs Linked To Increased ER Visits, Hospitalization in Older Adults
According to a study recently published in the journal Pharmacotherapy, anticholinergic drugs are associated with an increased rate of emergency room visits and hospital admissions.
Anticholinergic drugs are a class of medication that acts upon the neurochemical acetylcholine. Acetylcholine is a a chemical messenger in the brain that transfers signals between certain cells to affect how the body functions.
Essentially, these drugs inhibit some nerve impulses that are responsible for involuntary muscle movements in the lungs, gastrointestinal tract, urinary tract, and other areas in the body.
When I first became aware of this study, I knew I had to research this topic. Anticholinergic drugs are unbelievably common, and many people are taking multiple drugs in this class without knowing it.
In addition to the new findings, previous research has already linked regular use of these drugsto cognitive impairment, such as Alzheimer’s disease and dementia.
Admittedly, I didn’t know much about the subject. I first became aware of the potential side effects of anticholinergic drugs when I began developing closed-angle glaucoma. My opthamologist warned me “Before you have the laser surgery, don’t take any anticholinergic medications. They can make your eye pressure go way up.”
“Like Benadryl?” I asked. Yes, she said. “If it says don’t use if you have glaucoma, don’t take it. That’s you.” At 44, I’m relatively young to have to worry about glaucoma. But for others with advancing age, this is yet another risk posed by the use of these drugs.
The list of drugs that have anticholinergic properties is extensive. They can include those intended to treat anxiety, depression, pain, allergies, incontinence, or insomnia.
As many as 50% of older adults take one ore more of these drugs, and in fact, it’s common to see multiple instances of these drugs in an older patient’s medication regimen.
About The Study
For the study, researchers looked at the prescription history of 3,344 patients from the Regenstrief Medical Record System.
They sought to determine how much anticholinergic medication each patient used (a.k.a. anticholinergic burden) as well as how often the individual used emergency healthcare, such as ambulance, emergency room, and hospitalization services.
In this study, anticholinergic burden was defined as the number of days the medication was dispensed multiplied by the strength of the anticholinergic load. The majority of the patients were female, and nearly two-thirds were African-American. Less than 10% were cognitively impaired.
Study researcher Noll Campbell, PharmD, Indiana University Center for Aging Research:
“Anticholinergics, the medications that block acetylcholine, a nervous system neurotransmitter, have previously been implicated as a potential cause of cognitive impairment, by us and by other researchers.”
“This is the first study to calculate cumulative anticholinergic burden and determine that as burden increases, so does healthcare utilization in the U.S. – both outpatient and inpatient.”
Results revealed that every day use of a drug with strong anticholinergic effects increased the chance of inpatient admission by 33% over one year.
Drugs considered “strong” are sleeping pills and antihistamines, both commonly used by older adults and widely available over-the-counter.
Even taking a drug with mild anticholinergic effects every day, such as those to treat heart failure and hypertension, increased the chance of inpatient admission by 11%.
“Individuals taking anticholinergics should talk with their doctors or pharmacists about possible alternatives, This new study provides stronger motivation to design and conduct de-prescribing studies to determine safe ways to take individuals off anticholinergic medications in the interests of preserving brain health and decreasing healthcare utilization rates and their potential costs.”
The study was conducted by researchers at Indiana University (IU) Center for Aging Research, IU Center for Health Innovation, and Implementation Science and Regenstrief Institute.
In 2013, the IU Center for Aging Research previously reported that continual use of strong anticholinergics for just 2 months could lead to memory problems and other symptoms of cognitive impairment.
Taking multiple drugs with weaker effects could result in cognitive impairment in just 3 months.
In addition, a 2015 study published in JAMA Internal Medicine analyzed data from more than 3,000 dementia-free older individuals beginning in 1994. Their drug use and cognitive function was then tracked over two decades.
Results showed that the higher the dose of anticholingeric drugs and longer the duration of use, the greater the risk for dementia. For this study, the most common drugs in this class were OTC antihistamines, nighttime pain relieves, antidepressants, and medications which treat incontinence or overactive bladder.
From the study:
“Higher cumulative anticholinergic use is associated with an increased risk for dementia. Efforts to increase awareness among health care professionals and older adults about this potential medication-related risk are important to minimize anticholinergic use over time.”
Older adults really need to be more aware of the risks of taking these medications, and be able to identified exactly which medications have these properties. Part of the problem is that there are so many drugs having anticholinergic properties currently being used to treat older adults.
Simply put, patients often do not realize what the side effects of a high “anticholinergic burden” can entail.
~ G. Nathalee Serrels, M.A., Psychology