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Bidarolli M, Das B, Rawat VS, Manocha S, Sony HT, Agnihotri A, Gupta M, Agera F. Polypharmacy and anticholinergic burden scales in older adults: a cross-sectional study among psychiatric outpatients in a tertiary care hospital. BMC Geriatr 2025; 25:43. [PMID: 39833708 PMCID: PMC11744821 DOI: 10.1186/s12877-024-05584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 11/25/2024] [Indexed: 01/22/2025] Open
Abstract
INTRODUCTION Mental disorders are prevalent among older adults, often leading to the use of multiple medications, many with anticholinergic properties. Polypharmacy, common in this population, is a major contributor to anticholinergic burden, which is linked to cognitive and physical decline. This study investigates the relationship between polypharmacy and anticholinergic burden across seven anticholinergic burden scales in elderly patients attending the psychiatric outpatient. METHODS Study was conducted at a psychiatry outpatient clinic at All India Institute of Medical Sciences, Rishikesh, India, from December 2021 to March 2023. Elderly patients (aged ≥ 60 years) who were on at least one psychotropic medication and had a primary working diagnosis of psychiatric illness were included. All psychotropic medications, including antidepressants, antipsychotics, mood stabilizers, and hypnotics, were evaluated. Anticholinergic burden scales were calculated by the respective tools. Univariate analysis was adopted to determine the factors that may affect polypharmacy. RESULTS Study included 1165 elderly patients aged ≥ 60 years. The prevalence of polypharmacy was 20.43% (n = 238). Clonazepam (n = 364, 17.28%), escitalopram (n = 197, 9.35%), metformin (n = 165, 7.83%), sertraline (n = 141, 6.69%), mirtazapine (n = 129, 6.12%), and lorazepam (n = 110, 5.22%) were among the most frequently prescribed anticholinergic drugs. Univariate analysis demonstrated that all anticholinergic risk assessment scales were closely correlated with polypharmacy, with the strongest association observed for the Anticholinergic Load Scale (ALS) (Odds Ratio = 4.3; p < 0.001). Polypharmacy was also positively associated with adverse drug reactions (Odds Ratio = 1.81; 95% Confidence Interval = 1.27-2.56). CONCLUSION The anticholinergic burden in this cohort of elderly psychiatry patients was high, with 95.1% (n = 1108) experiencing a significant burden. Adverse drug events and anticholinergic burden scales were positively associated with polypharmacy, with a stronger correlation between polypharmacy and ALS scores than with other anticholinergic burden scales in older adults.
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Affiliation(s)
- Manjunath Bidarolli
- Department of Pharmacology, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Sector 88, Faridabad, Haryana, 121002, India.
| | - Biswadeep Das
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, 249203, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, 249203, India
| | - Sachin Manocha
- Department of Pharmacology, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Sector 88, Faridabad, Haryana, 121002, India
| | - Hannah Theresa Sony
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, 249203, India
| | - Akash Agnihotri
- Department of Pharmacology, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Sector 88, Faridabad, Haryana, 121002, India
| | - Mahima Gupta
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, 249203, India
| | - Franklin Agera
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, 576104, India
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Salvi F, Petrino R, Conroy SP, Liperoti R, Paoletti L, Beccacece A, dell'Aquila G, Fedecostante M, Cherubini A. Constipation: a neglected condition in older emergency department patients. Intern Emerg Med 2024; 19:1977-1986. [PMID: 39083165 DOI: 10.1007/s11739-024-03724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/22/2024] [Indexed: 10/11/2024]
Abstract
Constipation and fecal impaction are common issues with the potential for significant morbidity in older people presenting to the Emergency Department (ED). While many of these patients present with classical symptoms of constipation or fecal impaction, atypical presentations are also frequent. These atypical presentations may include paradoxical diarrhea, fecal incontinence, urinary retention or overflow incontinence, hyperactive or hypoactive delirium, anorexia/dysphagia, and syncope. In addition, various clinical conditions (such as dementia, Parkinson's disease, dehydration, and hypothyroidism) and medications (such as opiate analgesics, anticholinergics, diuretics, calcium channel blockers, anti-parkinsonian drugs, and oral iron supplements) are associated with constipation and should be considered during the diagnostic process in the ED. This narrative review specifically focuses on the prevalence, presentation, diagnoses, and management of constipation in older ED patients.
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Affiliation(s)
- Fabio Salvi
- Department of Geriatrics and Emergency Care, IRCCS, Italian National Research Centres on Aging (I.N.R.C.A.), Via della Montagnola n. 81, 60127, Ancona, Italy.
| | - Roberta Petrino
- Department of Critical Care, Emergency Medicine Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Simon P Conroy
- Medical Research Council (MRC) Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Paoletti
- Department of Geriatrics and Emergency Care, IRCCS, Italian National Research Centres on Aging (I.N.R.C.A.), Via della Montagnola n. 81, 60127, Ancona, Italy
| | - Alessia Beccacece
- Department of Geriatrics and Emergency Care, IRCCS, Italian National Research Centres on Aging (I.N.R.C.A.), Via della Montagnola n. 81, 60127, Ancona, Italy
| | - Giuseppina dell'Aquila
- Department of Geriatrics and Emergency Care, IRCCS, Italian National Research Centres on Aging (I.N.R.C.A.), Via della Montagnola n. 81, 60127, Ancona, Italy
| | - Massimiliano Fedecostante
- Department of Geriatrics and Emergency Care, IRCCS, Italian National Research Centres on Aging (I.N.R.C.A.), Via della Montagnola n. 81, 60127, Ancona, Italy
| | - Antonio Cherubini
- Department of Geriatrics and Emergency Care, IRCCS, Italian National Research Centres on Aging (I.N.R.C.A.), Via della Montagnola n. 81, 60127, Ancona, Italy
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Srikartika VM, Ha N, Youens D, Moorin R. Assessing the feasibility of anticholinergic burden scales and measures in administrative data: A systematic review. Arch Gerontol Geriatr 2024; 129:105646. [PMID: 39388728 DOI: 10.1016/j.archger.2024.105646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/06/2024] [Accepted: 09/28/2024] [Indexed: 10/12/2024]
Abstract
AIM This systematic review aimed to identify and evaluate the quality and adaptability of existing anticholinergic burden scales and measures by using administrative dispensing data. METHOD A comprehensive literature search was conducted using the Medline, Embase, CINAHL, and Google Scholar databases from 2001 to 2022. Studies that introduced, updated, or modified anticholinergic burden scales and measures were included in this review. Quality assessment considered various aspects, including scoring systems, tool development criteria, and specific requirements tailored for administrative data. RESULTS Twenty-eight anticholinergic burden scales and measures were identified in 14 countries. The Modified Anticholinergic Risk Scale excelled in the scoring system, while the German Anticholinergic Burden Scale stood out in the scale development process. However, significant variability was observed in methodologies, medication listings, and adaptability to administrative data. Quality assessment considers aspects such as potency, dose, exposure duration, longitudinal measurement, clinical interpretation, and compatibility with administrative data variables. The evaluation also considered tool development criteria including evidence for medication selection, panel expertise, relevance, updating methods, international applicability, validation, and clinical guidance. CONCLUSION This review emphasizes the importance of adaptable and robust tools that can work well with administrative data to ensure patient safety and better health outcomes, given the ongoing evolution of anticholinergic medications. The findings of this systematic review provide valuable insights for clinicians and researchers in selecting the most appropriate anticholinergic burden scale or measure according to their specific needs and data sources. This systematic review was registered with PROSPERO (registration ID CRD42023423959).
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Affiliation(s)
- Valentina M Srikartika
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia 6102, Australia; Pharmacy Program Study, Faculty of Mathematics and Natural Science, Lambung Mangkurat University, Banjarbaru, South Kalimantan 70714, Indonesia.
| | - Ninh Ha
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia 6102, Australia
| | - David Youens
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia 6102, Australia
| | - Rachael Moorin
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia 6102, Australia
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Baboudjian M, Peyronnet B, Boissier R, Robert G, Cornu JN, Misrai V, Pradere B. Best nonsurgical managements of acute urinary retention: what's new? Curr Opin Urol 2022; 32:124-130. [PMID: 34954701 DOI: 10.1097/mou.0000000000000969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR). RECENT FINDINGS A recent meta-analysis confirmed that α-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (-89.68 min, 95% confidence interval -160.55, -18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR. SUMMARY The recent development of alternative approaches to traditional TWOC may lead to new therapies for treating patients with AUR. Further studies are needed as the level of evidence from published studies remains low.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, La Conception Hospital
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille
| | | | | | - Grégoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux
| | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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