Adverse effects that are not just a sign of getting older – the anticholinergic burden

Falls, confusion, cognitive decline, dry mouth, constipation and urinary retention. In a new NPS MedicineWise podcast episode released today, Dr Kate Annear, NPS MedicineWise medical adviser and GP talks about the new NPS MedicineWise educational program on the cumulative effects of anticholinergic medicines. Reviewing people’s multiple medicines and considering deprescribing or finding alternative treatments can reduce ‘anticholinergic burden’.

“Medicines with an anticholinergic effect are useful to treat many conditions such as depression, dementia with changed behaviour and chronic non-cancer pain,” says Dr Kate Annear, NPS MedicineWise medical adviser and GP.

“However, cumulatively, they can cause serious adverse effects which are particularly problematic for older people who may be more susceptible to anticholinergic burden and who may be taking multiple medicines.

“It is important to keep anticholinergic burden in mind. It is easy for older people experiencing symptoms to put them down to just getting older,” she says.

Anticholinergic burden is associated with poor health outcomes, particularly for older people, including a 60% increase in fall-related hospitalisations, 50% increased risk of dementia and a 30% increased mortality.

The NPS MedicineWise Anticholinergic burden: the unintended consequences for older people program aims to improve the health outcomes of older people living in the community and residential aged-care facilities (RACFs) by promoting the safe and effective use of medicines with anticholinergic effects and, as a result, reduce anticholinergic burden.

“A Home Medicines Review (HMR), or a Residential Medication Management Review (RMMR) if the person lives in an aged-care home is an important way to review medicines. It is important for the GP to provide the pharmacist with a detailed referral to get the most out of the review. Demographic and social history, medical and surgical history, relevant pathology results and a complete list of medicines with indications are all important,” she says.

The program includes resources to support conversations with patients about anticholinergics, deprescribing and medicine reviews, including a fact sheet, a decision aid, an action plan and Choosing Wisely 5 questions that a person can ask about anticholinergic medicines.

There is also a report for GPs participating in the MedicineInsight program, providing them with individualised data on their patients who are exposed to high anticholinergic burden. The report is based on the Drug Burden Index (DBI), which is a measure of the cumulative exposure to anticholinergic and sedative medicines. Professor Sarah Hilmer, Dr Lisa Kouladjian O'Donnell and Associate Professor Danijela Gnjidic, supported by the Northern Sydney Local Health District and The University of Sydney’s Faculty of Medicine and Health, provided expertise and resources related to the DBI to inform the report.

Visit the NPS MedicineWise website for more information and resources for health professionals and consumers from the Anticholinergic burden: the unintended consequences for older people program.