Resumen de Assessment of the anticholinergic burden in the elderly: A viable concern?
Alba Salguero Olid, Silvia González Suárez, Aída Rueda Naharro, Manuela Martínez Camacho, Encarnación Rodríguez Jiménez, David García Marco
Introduction: Anticholinergics can cause agitation, confusion, and dizziness at the central nervous system level, and in the long-term, cognitive impairment, memory loss, and delirium. Despite all the existing resources to measure the anticholinergic burden in the elderly, at present, there is no single standardized scale. The aim is to measure the anticholinergic burden automatically and simultaneously in the ten scales applicable to elderly patients, and to calculate the variability of the outcomes with the different equations.
Method: A Cross-sectional descriptive study was performed on patients ≥70 years of age. Using the Geridrugs® computerized system, the anticholinergic burden of the pharmacotherapy received by each patient was measured automatically and simultaneously in ten scales applicable to geriatric patients and the degree of concordance of the outcomes according to the classification of high-anticholinergic burden was estimated by using Microsoft Excel® equations. The patients with prescribed medications associated with dementia and the safest substitution alternatives were identified through the same application.
Results: Three hundred and forty-eight patients were included (61% were men), age 86 ±2.77 years. A significant percentage had a high burden (median = 30.17%; range = 7.13-37.68), although the results were different depending on the scale used. The degree of concordance for all ten scales was less than 20%, and for ≥6 scales, less than 6%. By automatically restricting those drugs with possible safer alternatives, it would be necessary to act on 2.87% of the patients due to the high-anticholinergic burden. The identified drugs with a high anticholinergic activity associated with dementia and with safer alternatives were clozapine, levomepromazine, pimozide, olanzapine, and oxybutynin.
Conclusion: The anticholinergic burden should be considered, decreased or avoided in older adults. The significant variability of the existing equations makes their widespread use inconsistent. The option of automatically searching for drugs associated with dementia or cognitive impairment with Geridrugs®, and with low —effect therapeutic alternatives that reduce the overall burden, makes it simpler to act in healthcare practice to enhance the patient’s safety taking drugs with anticholinergic activity.
