High-risk anticholinergic prescriptions are listed for 6.2% of visits of older adults, according to a study published in a recent issue of the Journal of the American Geriatrics Society.

Taeho Greg Rhee, Ph.D., from Yale University in New Haven, Conn., and colleagues estimated prescribing trends of and correlated independently associated with high-risk anticholinergic prescriptions among a national sample of adults aged 65 years and older from 2006 to 2015. Data were included for an unweighted sample of 96,996 adults.

Anticholinergic prescription

The researchers found that a high-risk anticholinergic prescription was listed for 6.2% of visits of older adults between 2006 and 2015, representative of 14.6 million total visits nationally.

Antidepressants, antimuscarinics, and antihistamines were the most common drug classes, accounting for more than 70% of prescribed anticholinergics. Female sex, the Southern geographic region, specific physician specialties, receipt of six or more concomitantly prescribed medications, and related clinical diagnoses correlated independently associated with greater odds of receiving a high-risk anticholinergic prescription.

Despite a range of clinical indications, medications with anticholinergic properties pose a number of risks to older adults. These agents are commonly prescribed for allergies, obstructive pulmonary disease, and urge urinary incontinence but they are associated with risks of serious adverse events, including cognitive impairment, falls, dementia, and death in older adults. 

This vulnerability to adverse events is due in large part to a variety of aging?related physiological changes such as poor hepatic and renal function and blood?brain barrier permeability. 

Although some of these medications rely directly on the anticholinergic action for their therapeutic effect (e.g., antispasmodics for irritable bowel syndrome and antimuscarinics for urge urinary incontinence), others have anticholinergic side effects separate from their therapeutic action (e.g., antidepressants and antihistamines).

"Our findings highlight that all types of physicians need to decrease prescribing of all classes of high-risk anticholinergic medications because safer alternatives are available," the authors write.

"The findings from our study lay the foundation for future research to develop and implement better quality of care practices to reduce high-risk anticholinergic prescriptions in older adults." One author disclosed financial ties to the pharmaceutical, medical device, and health insurance industries.

The prevalence of high?risk anticholinergic prescriptions was stable over time but varied according to physician specialty and drug class. Quality prescribing should be promoted because safer alternatives are available.