The effect of medication reviews on reducing medication anticholinergic burden in elderly patients

  • Howraa Abed

    Student thesis: Doctor of Philosophy (PhD) - CDU


    Introduction: Medications with anticholinergic properties, as their main effect or as a side effect, are widely prescribed, especially among the elderly to manage different health conditions.

    Recent studies demonstrate that the use of medications with anticholinergic activity increase the risk of cognitive function decline, and physical or mental impairment, however the intensity of this response vary depending on the individual response. Thus, those effects are often missed, especially in the elderly or patients with a pre-existing condition such as dementia. These effects can be serious and may lead to an increased risk of mortality.

    Aim: The main aim of the study is to explore if the home medication review process can contribute to anticholinergic burden reduction caused by medications with anticholinergic side effects in elderly patients.

    Design and Methods: Prospective observational case-control studies, where two sessions of patient encounters—baseline and six-month follow—up were performed by the researcher. The researcher calculated the anticholinergic burden caused by medication side effect of each participant patient based on their current medications, excluding those medications used specifically as anticholinergics, and recommended alternatives that are possible to contribute to reduction in the patient total anticholinergic burden. The researcher observed participants in collaboration with their treating doctors. The study compared patients’ outcomes of those who have investigator’s recommendations implemented (cases) with those who did not have the investigator’s recommendations implemented (controls) by their treated doctor.

    The measurable variances were the reduction in the score on the Anticholinergic Cognitive Burden scale, improvement in the Kessler psychological distress scale and improvement in worried about your memory results. The investigator delivered both the initial and the follow-up medication reviews, which included the administration of the two tools and calculation of the anticholinergic cognitive burden scale score and drug change recommendations to treating doctors. Pharmacist doctor collaboration was noted to understand if doctors are prepared for this level of collaboration.

    Results: Medication reviews conducted by the pharmacist revealed that medications changes were possible to reduce the anticholinergic cognitive burden score, but occasionally are impractical to implement due to patients’ medical conditions, drug interaction with their other medications and patient choice. When it was practical to change them the pharmacist’s recommendations were in most cases disregarded by doctors for reasons that were not communicated to the pharmacist.

    The study revealed that 60.40% of the participants had high anticholinergic burden score that did not correspond to the worried about your memory and Kessler psychological distress scale results. However, using statistical models the anticholinergic cognitive burden scale score was shown to have a significant impact on the Kessler psychological distress scale and an indirect impact on the worried about your memory ‘yes’ outcome through the total Kessler psychological distress scale score variables. Total Kessler psychological distress scale score can be used to potentially predict worried about your memory and vice versa. The type of medical conditions has been shown to affect both.

    The study also showed that it was possible to the pharmacists to administer the Kessler psychological distress scale and the worried about your memory questionnaires during medications reviews and to calculate the anticholinergic cognitive burden scale score afterword with marginal 30 minutes increase in time taken to complete the medication review; this can be beneficial to patients and to the treating doctor to know.

    Conclusion: The study does not draw a clear conclusion on pharmacist ability to improve older patients’ cognitive functions through recommending alternative medications due to unavoidable factors that should be addressed by the appropriate professional bodies to improve communication between pharmacists and doctors to ensure that pharmacists’ recommendations were seriously reviewed and considered. Further research on the topic is required to further validate the study findings.

    Date of Award2016
    Original languageEnglish
    SupervisorPatrick Ball (Supervisor)

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