Prevalence, Predictors and Healthcare Impact of Anticholinergic Medications Use in Elderly Dementia Patients

Objectives: The purpose of this study was (i) to determine the prevalence of anticholinergic drugs use in elderly dementia patients (ii) to determine predictors of anticholinergic drugs use in elderly dementia patients (iii) to assess the association between the use of drugs with anticholinergic properties and Health-related Quality of life (HRQoL) among community-dwelling elderly dementia patients.

Methods: Retrospective cross-sectional study design and longitudinal panel design was conducted using the 2005-2009 Medical Expenditure Panel Survey (MEPS) data, a nationally representative data on the community dwelling, non-institutionalized US population to determine the predictors and impact on HRQoL, respectively. The study sample included patients aged ≥65 years with dementia. The anticholinergic drugs were identified using Anticholinergic Drug Scale (ADS), which classifies drugs into four levels of increasing orders of anticholinergic activity. Weighted descriptive statistics were performed to estimate the prevalence of anticholinergic drugs use. Multiple logistic regression within the conceptual framework of Anderson Behavioral Model was performed to identify predictors associated with the use of anticholinergic drugs. Use of drugs with marked anticholinergic activity (ADS level-2 or 3) was the dependent variable. Multiple linear regression were performed to determine the association of anticholinergic medications use and HRQoL with dependent variables as Physical component score (PCS) and Mental component score (MCS). The primary independent variable was the use of anticholinergic drugs (ADS level-1, 2 or 3). Predisposing, enabling, and need characteristics were controlled for all objectives.

Results: According to MEPS there were a total of 1,564,143 (95% CI: 1,397,000, 1,731,287) elderly had dementia diagnosis. 60.29% (95% CI: 55.63, 64.95) of the elderly dementia patients used at least one anticholinergic drug. Approximately 23.4% (95% CI: 19.24, 27.57) elderly dementia patients used a higher level of anticholinergic drugs (ADS levels 2 or 3). Of the enabling factors, the odds of receiving higher-level anticholinergic drugs were significantly lower for patients who resided in the west region (OR: 0.40; 95% CI: 0.17 – 0.95) compared to the reference group, Northeast. Among the need factors, elderly dementia patients having mood disorders (OR: 2.13; 95% CI: 1.15, 3.94) and urinary incontinence (6.40; 95% CI: 2.73, 15.03) were more likely to use drugs with marked anticholinergic activities. The final cohort to determine the impact of anticholinergic medications use on HRQoL consisted of unweighted sample size of 112 patients. Anticholinergic drug use among elderly dementia patients reduced the physical component score by 8.12 units compared to non-users (p-value: 0.0004) whereas no significant difference between users and non-users of anticholinergic on mental component score.

Conclusions: Over one in five elderly dementia patients used drugs with marked anticholinergic activities. Mood disorder, urinary incontinence and region were the significant predictors of marked anticholinergic medications use in elderly dementia patients. There is a strong need to optimize the use of anticholinergic drugs. Elderly dementia patients who were taking anticholinergic medications had poor physical component score but have no effect on mental component score. Future study should address the long-term impact of anticholinergic medications use on HRQoL.