Anticholinergic Medications Raise Risks for Seniors

Many medications frequently prescribed for seniors have anticholinergic activity. New research suggests that anticholinerg drugs are risky for older people.

Many medications show anticholinergic activity--they block or inhibit acetylcholine, a key neurotransmitter in the brain and nervous system.These medications are prescribed for many diseases, including gastro-intestinal conditions, uro-genital disorders, respiratory problems, heart conditions, Parkinson's and other nervous system disorders, and others.There is a growing body of evidence that anticholinergic medications are risky for older people, especially when a patient takes more than one.A new study in the Journal of the American Geriatrics Society finds that the more anticholinergic drugs seniors take, the more likely they are to suffer cognitive impairment and premature death.
"One of the issues is that as we age, we tend to be prescribed more medicines which have an anticholinergic effect, increasing the overall burden," says Ian Maidment, a pharmacist for the UK's National Health Service and one of the study's authors.
How many anticholinergic meds do seniors take?
Maidment and his colleagues studied 13,400 men and women over the age of 65 who were participating in a long-term UK study of cognitive functioning and ageing.

The researchers calculated patients' anticholinergic loads by totaling the contribution of each of their medications. Each medication was rated on a scale from 0 to 3 depending on its anticholinergic impact.

About half of the participants were taking at least one drug with possible anticholinergic activity (score of 1), while 508 were taking one or more drugs with definite anticholinergic impact (scores of 2 or higher).

Multiple meds--multiple risks
Taking one or more medications with definite anticholinergic activity was associated with cognitive decline.
However, the most striking finding was that 20 percent of the seniors with anticholinergic medication scores of four more died during the two-year study, compared to just 7 percent of those who were not taking any anticholinergic drugs.
There was a linear relationship between anticholinergic load and the risk of dying. For every additional point earned, a patient's risk of dying within two years went up by 25 percent.
"As far as the authors are aware, this is the first team to identify a link between mortality and anticholinergic burden," the authors write,
The researchers point out that this finding does not mean that the anticholinergic medications caused these patients' deaths. In many cases, the drugs were prescribed to treat life-threatening conditions. "This finding should be treated with caution," they write, "because medications with possible anticholinergic effects are used for many diseases, such as hypertension and congestive heart failure."
Still, the link between anticholinergic load and the risk of dying remained even when the researchers used statistical techniques to account for pre-existing medical conditions.

The authors emphasize that elderly patients should not stop taking any prescribed medication because of this study. However, they recommend that patients schedule regular medication reviews with their physicians to determine if their anticholinergic medications are necessary.

##This information is for educational purposes only and should not be considered medical advice.

Reference: C. Fox et al., Anticholinergic medication use and cognitive impairment in the older population, Journal of the American Geriatrics Society, June 24, 1011.