Interventions for reducing anticholinergic medication burden in older adults-a systematic review and meta-analysis

Abstract

Introduction: Anticholinergic medications block the neurotransmitter acetylcholine in the brain and peripheral nervous system. Many medications have anticholinergic properties, and the cumulative effect of these medications is termed anticholinergic burden. Increased anticholinergic burden can have short-term side effects such as dry mouth, blurred vision and urinary retention as well as long-term effects including dementia, worsening physical function and falls.

Methods: We carried out a systematic review (SR) with meta-analysis (MA) looking at randomised controlled trials addressing interventions to reduce anticholinergic burden in older adults.

Results: We identified seven papers suitable for inclusion in our SR and MA. Interventions included multi-disciplinary involvement in medication reviews and deprescribing of AC medications. Pooled data revealed no significant difference in outcomes between control and intervention group for falls (OR = 0.76, 95% CI: 0.52-1.11, n = 647), cognition (mean difference = 1.54, 95% CI: -0.04 to 3.13, n = 405), anticholinergic burden (mean difference = 0.04, 95% CI: -0.11 to 0.18, n = 710) or quality of life (mean difference = 0.04, 95% CI: -0.04 to 0.12, n = 461).

Discussion: Overall, there was no significant difference with interventions to reduce anticholinergic burden. As we did not see a significant change in anticholinergic burden scores following interventions, it is likely other outcomes would not change. Short follow-up time and lack of training and support surrounding successful deprescribing may have contributed.

Keywords: anticholinergic medication; cognition; falls; meta-analysis; older adult; older people; systematic review.

Figure 1

Flowchart of included studies.

Figure 2

Forest plots demonstrating at follow-up, in the intervention and the control groups: (a) pooled risk estimates of fall frequency; (b) pooled mean differences in Mini-Mental State Examination (MMSE) scores; (c) pooled mean differences in Drug Burden Index (DBI) scores; (d) pooled mean differences in EuroQol five-dimension health questionnaire (EQ-5D) scores. In (a), odds ratios less than 1 favour the intervention group; odds ratios more than 1 favour the control group. In (b, c, d), mean difference less than 0 favours the control group, mean difference more than 0 favours the intervention group. CI = confidence interval; I² = I² statistic; IV = inverse variance; M-H = Mantel–Haenszel method; P = P value; Random = random effects; Z = Z value.