medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes
OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .
Anticholinergic medications in community-dwelling older veterans: prevalence of anticholinergic symptoms, symptom burden, and adverse drug events.
BACKGROUND The use of drugs with anticholinergic adverse effects is often deemed inappropriate in elderly ( aged > or = 65 years ) patients , yet studies continue to show extensive use in this population at high risk for adverse drug events ( ADEs ) . The burden of drug-related anticholinergic symptoms in community-dwelling elderly patients has not been well described . OBJECTIVE The aim of this study was to assess the prevalence of anticholinergic symptoms , corresponding symptom burden , and anticholinergic-related ADEs in a sample of community-dwelling elderly veterans . METHODS This prospect i ve cohort study was conducted at the primary care clinics at the Veterans Affairs Medical Center ( VAMC ) , Iowa City , Iowa . The study sample included r and omly selected patients with intact cognitive function attending the VAMC and prescribed > or = 5 scheduled medications . Data on current prescription and nonprescription drug use were elicited by a trained research assistant and a clinical pharmacist from patient interviews and electronic medical records . The prevalence and severity of 7 anticholinergic symptoms ( dry mouth , constipation , blurred vision , confusion , urinary hesitation , dry eyes , and drowsiness ) were assessed at baseline . The occurrence of ADEs at 12 weeks was compared between patients using anticholinergic drugs and those not using them . RESULTS A total of 532 patients were included ( 97.9 % men ; mean age , 74.3 years ; 27.1 % used at least 1 anticholinergic drug )  . Twenty-two anticholinergic drugs ( 16 prescription medications , 6 over-the-counter medications ) were identified . The mean number of anticholinergic symptoms was significantly higher in the group using anticholinergic drugs ( 3.1 vs 2.5 ; P < 0.01 ) . However , only 2 symptoms were statistically more prevalent in the group using anticholinergic drugs : dry mouth ( 57.6 % vs 45.6 % ) and constipation ( 42.4 % vs 29.4 % ) ( both , P < 0.01 ) . At 12 weeks , only 1 ( 0.8 % ) patient in the group using anticholinergic drugs reported an ADE considered related to an anticholinergic drug . CONCLUSIONS Anticholinergic drug use was common ( 27.1 % ) in these elderly veterans with intact cognitive function . The mean number of anticholinergic symptoms was significantly greater in this group , and the prevalences of dry mouth and constipation were significantly higher in the group using anticholinergic drugs ( all , P < 0.01 ) . Anticholinergic-related ADEs were rare ( 0.8 % ) . Although anticholinergic drugs should generally be avoided in the elderly , individual risks and benefits for a patient should be considered
medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes
OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes .