High-Risk Anticholinergics Often Prescribed in Older Adults

High-risk anticholinergics were prescribed to older adults in more than 14 million physician visits from 2006 and 2015, according to new estimates. Now, researchers are emphasizing the importance of better prescribing practices and safer alternatives to these medications.

In hopes of determining modern prescribing trends for high-risk anticholinergics, researchers recently evaluated a national sample of 96,996 physician visits made by adults aged 65 years and older between 2006 and 2015.
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Any prescriptions of high-risk anticholinergics were identified and recorded, and prescribing trends from 2006 to 2015 were estimated. A multivariable logistic regression analysis was performed to estimate the likelihood of high-risk anticholinergic prescription.

Data on physician specialty and anticholinergic drug class were also taken into account in stratified analyses.

Ultimately, the prevalence of high‐risk anticholinergic prescriptions was found to be “stable over time but varied according to physician specialty and drug class,” the researchers wrote. Results indicated that high-risk anticholinergics were prescribed in 5876 (6.2%) of physician visits made by older adults between 2006 and 2015, which was representative of 14.6 total visits nationally.

Antidepressants, antimuscarinics, and antihistamines were the most commonly prescribed classes of drugs, accounting for more than 70% of anticholinergic prescriptions.

Factors associated with a higher likelihood of high-risk anticholinergic prescription included female sex; Southern geographic location; specific physician specialties, such as psychiatry and urology; receipt of 6 or more concomitantly prescribed medications, and related clinical diagnoses, such as urinary incontinence.

With these findings in mind, the authors are reiterating the importance of quality prescribing for high-risk anticholinergics because “safer alternatives are available,” they wrote.

—Christina Vogt

Reference:

Rhee TG, Choi YC, Ouellet GM, Ross JS. National prescribing trends for high-risk anticholinergic medications in older adults [Published online March 26, 2018]. J Am Geriatr Soc. https://doi.org/10.1111/jgs.15357.