Potentially inappropriate anticholinergic drug use among older adults in primary healthcare: prevalence and determinants

ABSTRACT

Background

Considering the vulnerability of older adults to adverse drug reactions, medications with strong anticholinergic properties are considered potentially inappropriate for this population. This study aims to characterize older adults’ profile of anticholinergics use and to identify the factors associated with their potentially inappropriate use.

Research design and methods

A retrospective study was conducted on 1200 older adults in primary health care centers of Portugal between April 2021 and August 2022. Potentially inappropriate use was assessed according to the 2023 Beers criteria. Logistic regression analyses were performed to determine associations between independent variables and potentially inappropriate use.

Results

A 8.9% (95% CI 0.074–0.107) of the older adults were exposed to one or more potentially inappropriate anticholinergics, and amitriptyline was the most used (2.0%). Multivariate analysis revealed that use was associated with a higher mean number of medications (OR 1.173, 95% CI 1.115–1.234), diagnoses of depression (OR 2.889, 95% CI 1.785–4.674) and psychiatric disorders (OR 1.654, 95% CI 1.003–2.729).

Conclusions

This study underscores the importance of vigilance in prescribing anticholinergic medications to older adults, particularly those with higher medication burdens and mental health diagnoses. By identifying factors associated with potentially inappropriate use, healthcare providers can better tailor medication regimens to mitigate risks and optimize the well-being of older adults.

KEYWORDS:

• Potentially inappropriate anticholinergic drugs
• older adults
• primary health care
• Portugal
• Beers criteria

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Daniela A. Rodrigues. The first draft of the manuscript was written by Daniela A. Rodrigues and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethics approval

This study is part of the APIMedOlder project that obtained ethics approval from the ARSC of Portugal (P33–2021).

Data availability statement

Data can be made available upon reasonable request.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14740338.2024.2385479.

Additional information

Funding

Daniela A. Rodrigues is funded by an individual grant from the Foundation for Science and Technology (FCT) [ref 2022.10605.BD].