Older adults with multiple health conditions frequently take many medications. When taken in combination, common drugs with anticholinergic properties (including over-the-counter sleep aids, antihistamines, tricyclic antidepressants, and some medications for bladder control) may negatively impact cognition, resembling the dementia of Alzheimer’s disease. Investigators at the University of Kentucky College of Public Health, in collaboration with other UK colleagues at the Sanders-Brown Center on Aging, the UK College of Pharmacy and the UK College of Medicine, completed a randomized clinical interventional trial to decrease anticholinergic burden and optimize medication appropriateness in older adults. The results appear in Alzheimer’s Research and Therapy.
[Photo: Dr. Daniela C. Moga (left) and Dr. Erin Abner]
Researchers conducted an 8-week, parallel-arm, randomized trial to evaluate whether a targeted patient-centered pharmacist-physician team medication therapy management intervention (“targeted MTM intervention”) reduced the use of inappropriate anticholinergic medications in older patients enrolled in a longitudinal cohort at University of Kentucky Sanders-Brown Alzheimer’s Disease Center. Study outcomes included changes in the medication appropriateness index (MAI) targeting anticholinergic medications and in the anticholinergic drug scale (ADS) score from baseline to the end of study.
Between October 1, 2014, and September 30, 2015, investigators enrolled and randomized 50 participants taking at least one medication with anticholinergic properties. Of these, 35 (70 percent) were women, 45 (90 percent) were white, and 33 (66 percent) were cognitively intact with a clinical dementia rating of zero. The mean age of participants was 77.7. At baseline, the mean MAI was 12.6 ± 6.3; 25 (50 percent) of the participants used two or more anticholinergics, and the mean ADS score was 2.8 ± 1.6.
After randomization, although no statistically significant difference was noted between groups, investigators identified a potentially meaningful imbalance as the intervention group had more participants with intact cognition, and thus included CDR in all of the analyses. The targeted MTM intervention resulted in statistically significant CDR adjusted differences between groups with regard to improved MAI (change score of 3.6 (1.1) for the MTM group as compared with 1.0 (0.9) for the control group, p = 0.04) and ADS (change score of 1.0 (0.3) for the MTM group as compared with 0.2 (0.3) for the control group, p = 0.03).
The investigators conclude: “[the] targeted Medication Therapy Management intervention resulted in improvement in anticholinergic medication appropriateness and reduced the use of inappropriate anticholinergic medications in older patients. [The] results show promise in an area of great importance to ensure optimum outcomes for medications used in older adults.”
Study authors include Dr. Daniela C. Moga, assistant professor in the UK College of Pharmacy who holds a joint appointment as an assistant professor in the UK College of Public Health Department of epidemiology, and Dr. Erin Abner, assistant professor in the department of epidemiology, who also holds a joint appointment in the UK Sanders-Brown Center on Aging and the Graduate Center for Gerontology.