Prevalence of Anticholinergic Medication Use in the Program of All-Inclusive Care for the Elderly

Abstract

Objectives: Evaluate the prevalence of anticholinergic medication use in the Program of All-Inclusive Care for the Elderly (PACE).

Design: Cross-sectional, retrospective chart review.

Setting: The Basics at Jan Werner PACE, Amarillo, Texas.

Participants: PACE participants (n = 128) and long-term care residents (n = 105) 65 years of age and older.

Main outcome measure: The primary outcome was percentage of prescribed medications with anticholinergic properties and risk factors associated with prescribing: study site, gender, race, age, and creatinine clearance.

Results: Anticholinergic medication prescribing was significantly lower in the PACE program (2.3% of total medications vs. 3.9%; P < 0.05) as well as total medication use (12.1 medications per subject vs. 20.8; P < 0.05 in the long-term care environment). Only the long-term care study site had a significant association with anticholinergic prescribing (odds ratio = 5.04, confidence interval 2.71-9.38). PACE participants also had lower Anticholinergic Risk Scale scores (score of 0, 60.2% PACE vs. 16.2%), reduced fall rates (23.8 per month PACE vs. 66.9), and similar hospitalization rates (5.4 per month PACE vs. 5.7).

Conclusion: PACE participants were prescribed fewer medications and had lower anticholinergic burden, which potentially lowers their risk of adverse effects. These data support the PACE interdisciplinary model by demonstrating the benefit of team care in appropriate use of medications. It provides a potential blueprint to organizations aimed at reducing potentially inappropriate medication prescribing in older adults.