Exposure to anticholinergic and sedative medicines as indicators of high-risk prescriptions in the elderly

Abstract

Background There are several assessment scales to evaluate the risk of falls or the adverse drug reaction risk. Few are sufficiently specific to assess the impact of drug prescriptions on falls in geriatric populations. Objective To define the risk of anticholinergic and sedation-related ADRs in an elderly hospitalized patient population using the Drug Burden Index (DBI), Anticholinergic Drug Scale (ADS), and Sedative Load Model (SLM). Setting Five geriatric university hospital centers in France. Method Multicenter prospective cohort study from 2011 to 2013. Drug prescriptions were compiled to estimate anticholinergic and sedative exposure. Any associations between the drug scales and falls were assessed. Main outcome measure Drug exposure estimated with the DBI, ADS, and SLM scales. Results 315 patients, with a mean age of 87 years and 117 documented falls, were included from 5 geriatric hospitals. Sixty-one percent of these patients had a DBI > 0, 20.3% had an ADS ≥ 3, 56.2% a SLM > 0. No association was detected between the scores and the risk of a fall (p > 0.05). Factors significantly associated with a risk of a fall were: a prior history of a fall in the previous 12 months (adjusted odds ratio [aOR] = 7.24, 4.06-12.89), orthostatic hypotension ([aOR] = 2.84; 1.39-5.79), or prescription of antidepressants ([aOR] = 2.12; 1.17-3.84). Conclusion A specific scale to identify high-risk prescriptions would help clinicians and pharmacists to optimize therapeutic treatments for the elderly. In light of the multifactorial characteristics of falls, predicting their risk should be based on a well-defined set of factors.

Keywords: Adverse effects; Aged; Anticholinergic medication; Falls; France; Pharmaceutical care; Sedative medication.