Taking the burden out of anticholinergic medicines

Falls, confusion, constipation, cognitive decline – these are all symptoms commonly associated with growing older.
 
But they could also signify something more sinister such as medicine-related adverse effects.
 
That is why NPS MedicineWise is launching an ‘Anticholinergic burden: the unintended consequences for older people’ program, which sheds light on the potential cumulative effects of anticholinergic medicines.
 
‘Studies tell us that the use of one or more anticholinergic medications has been associated with an increased risk of cognitive decline, delirium, dementia, falls, fractures, and mortality for older people,’ GP Dr Kate Annear said during a recent NPS MedicineWise podcast.
 
‘So, you can see it’s a really relevant and important issue.’
 
While anticholinergic burden is not a new concept, it has long been linked to poor health outcomes.
 
These commonly used medicines block the action of the neurotransmitter acetylcholine in the central and peripheral nervous system, which can be quite useful in the appropriate clinical situation where the effect is desired. But it can also pose a problem for elderly patients who are more likely to be taking multiple medicines.
 
For this reason, more than a decade ago Australian researcher Professor Sarah Hilmer and her team from the University of Sydney pioneered the Drug Burden Index (DBI), to measure the cumulative exposure to anticholinergic and sedative medicines.
 
It is also why Dr Annear believes it is important to ‘keep anticholinergic burden in mind’, especially as it is ‘easy’ for ageing people to attribute symptoms to simply getting older.
 
‘Medicines with an anticholinergic effect are useful to treat many conditions such as depression, dementia with changed behaviour, and chronic non-cancer pain,’ Dr Annear said.
 
‘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.’
 
The new NPS MedicineWise program hopes to improve the health outcomes of older people living in the community and residential aged care facilities by promoting the safe and effective use of medicines with anticholinergic effects.
 
Among the many resources are a medicines review fact sheet, a decision aid, an action plan and the Choosing Wisely 5 questions to support GPs in conversations about anticholinergic medicines with patients.
 
In addition, the DBI calculator, along with expert input from Professor Hilmer’s team and the Northern Sydney Local Health District, was used to inform the MedicineInsight practice report as part of the program for participating GPs.
 
And with elderly patients slowly gaining the confidence to return to their GP in person, Dr Annear believes it is an ideal time for GPs to review their medicines.
 
‘GPs are incredibly busy and COVID has made everything a lot harder,’ she said.
 
‘Now is real the time to rethink that big picture again and update our skill set on medications − and we have the perfect opportunity to look at anticholinergic burden.’
 
More information on the program is available on the NPS MedicineWise website.
 
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anticholinergic medicines elderly geriatrics medications medicines polypharmacy