Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects

Maire O'Dwyer, A. Belton, Jure Peklar, Ian Maidment, Philip McCallon, Mary McCarron, Martin C. Henman

Research output: Contribution to conferencePaper

Abstract

Background: Anticholinergic medications may be associated with adverse clinical outcomes, including acute impairments in cognition and anticholinergic side effects, the risk of adverse outcomes increasing with increasing anticholinergic exposure. Older people with intellectual disability may be at increased risk of exposure to anticholinergic medicines due to their higher prevalence of comorbidities. We sought to determine anticholinergic burden in ageing people with intellectual disability.
Methods: Medication data (self-report/proxy-report) was drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a study on the ageing of 753nationally representative people with an IDC40 years randomly selected from the National Intellectual Disability Database. Each individual’s cumulative exposure to anticholinergic medications was calculated using the Anticholinergic Cognitive Burden Scale (ACB) amended by a multi-disciplinary group with independent advice to account for the range of medicines in use in this population.
Results: Overall, 70.1 % (527) reported taking medications with possible or definite anticholinergic properties (ACBC1), with a mean (±SD) ACB score of 4.5 (±3.0) (maximum 16). Of those reporting anticholinergic exposure (n=527), 41.3 % (217) reported an ACB score o fC5. Antipsychotics accounted for 36.4 % of the total cumulative ACB score followed by anticholinergics (16 %) and antidepressants (10.8 %). The most frequently reported medicine with anticholinergic activity was carbamazepine 16.8 % (127). The most frequently reported medicine with high anticholinergic activity (ACB 3) was olanzapine13.4 % (101). There was a significant association between higher anti-cholinergic exposure and multimorbidity, particularly mental health morbidity, and some anticholinergic adverse effects such as constipation and day-time drowsiness but not self-rated health.
Conclusion: Using simple cumulative measures proved an effective means to capture total burden and helped establish that anticholinergic exposure in the study population was high. The finding highlights the need for comprehensive reviews of medications.
LanguageEnglish
DOIs
Publication statusPublished - 1 Sep 2014
EventIGS 62nd Annual and Scientific Meeting Science for Healthy & Active Ageing - Galway, Ireland
Duration: 9 Oct 201411 Oct 2014

Conference

ConferenceIGS 62nd Annual and Scientific Meeting Science for Healthy & Active Ageing
CountryIreland
CityGalway
Period9/10/1411/10/14

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Cholinergic Antagonists
Intellectual Disability
Comorbidity
Disabled Persons
Medicine
Sleep Stages
Carbamazepine
Proxy
Constipation

Bibliographical note

IGS 62nd Annual and Scientific Meeting Science for Healthy & Active Ageing,
Irish Journal of Medical Science, September 2014, Volume 183, Supplement 7, pp 269-387.

Cite this

O'Dwyer, M., Belton, A., Peklar, J., Maidment, I., McCallon, P., McCarron, M., & Henman, M. C. (2014). Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects. Paper presented at IGS 62nd Annual and Scientific Meeting Science for Healthy & Active Ageing, Galway, Ireland. https://doi.org/10.1007/s11845-014-1177-1
O'Dwyer, Maire ; Belton, A. ; Peklar, Jure ; Maidment, Ian ; McCallon, Philip ; McCarron, Mary ; Henman, Martin C. / Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects. Paper presented at IGS 62nd Annual and Scientific Meeting Science for Healthy & Active Ageing, Galway, Ireland.
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O'Dwyer, M, Belton, A, Peklar, J, Maidment, I, McCallon, P, McCarron, M & Henman, MC 2014, 'Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects' Paper presented at IGS 62nd Annual and Scientific Meeting Science for Healthy & Active Ageing, Galway, Ireland, 9/10/14 - 11/10/14, . https://doi.org/10.1007/s11845-014-1177-1

Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects. / O'Dwyer, Maire; Belton, A.; Peklar, Jure; Maidment, Ian; McCallon, Philip; McCarron, Mary; Henman, Martin C.

2014. Paper presented at IGS 62nd Annual and Scientific Meeting Science for Healthy & Active Ageing, Galway, Ireland.

Research output: Contribution to conferencePaper

TY - CONF

T1 - Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects

AU - O'Dwyer, Maire

AU - Belton, A.

AU - Peklar, Jure

AU - Maidment, Ian

AU - McCallon, Philip

AU - McCarron, Mary

AU - Henman, Martin C.

N1 - IGS 62nd Annual and Scientific Meeting Science for Healthy & Active Ageing, Irish Journal of Medical Science, September 2014, Volume 183, Supplement 7, pp 269-387.

PY - 2014/9/1

Y1 - 2014/9/1

N2 - Background: Anticholinergic medications may be associated with adverse clinical outcomes, including acute impairments in cognition and anticholinergic side effects, the risk of adverse outcomes increasing with increasing anticholinergic exposure. Older people with intellectual disability may be at increased risk of exposure to anticholinergic medicines due to their higher prevalence of comorbidities. We sought to determine anticholinergic burden in ageing people with intellectual disability.Methods: Medication data (self-report/proxy-report) was drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a study on the ageing of 753nationally representative people with an IDC40 years randomly selected from the National Intellectual Disability Database. Each individual’s cumulative exposure to anticholinergic medications was calculated using the Anticholinergic Cognitive Burden Scale (ACB) amended by a multi-disciplinary group with independent advice to account for the range of medicines in use in this population.Results: Overall, 70.1 % (527) reported taking medications with possible or definite anticholinergic properties (ACBC1), with a mean (±SD) ACB score of 4.5 (±3.0) (maximum 16). Of those reporting anticholinergic exposure (n=527), 41.3 % (217) reported an ACB score o fC5. Antipsychotics accounted for 36.4 % of the total cumulative ACB score followed by anticholinergics (16 %) and antidepressants (10.8 %). The most frequently reported medicine with anticholinergic activity was carbamazepine 16.8 % (127). The most frequently reported medicine with high anticholinergic activity (ACB 3) was olanzapine13.4 % (101). There was a significant association between higher anti-cholinergic exposure and multimorbidity, particularly mental health morbidity, and some anticholinergic adverse effects such as constipation and day-time drowsiness but not self-rated health.Conclusion: Using simple cumulative measures proved an effective means to capture total burden and helped establish that anticholinergic exposure in the study population was high. The finding highlights the need for comprehensive reviews of medications.

AB - Background: Anticholinergic medications may be associated with adverse clinical outcomes, including acute impairments in cognition and anticholinergic side effects, the risk of adverse outcomes increasing with increasing anticholinergic exposure. Older people with intellectual disability may be at increased risk of exposure to anticholinergic medicines due to their higher prevalence of comorbidities. We sought to determine anticholinergic burden in ageing people with intellectual disability.Methods: Medication data (self-report/proxy-report) was drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a study on the ageing of 753nationally representative people with an IDC40 years randomly selected from the National Intellectual Disability Database. Each individual’s cumulative exposure to anticholinergic medications was calculated using the Anticholinergic Cognitive Burden Scale (ACB) amended by a multi-disciplinary group with independent advice to account for the range of medicines in use in this population.Results: Overall, 70.1 % (527) reported taking medications with possible or definite anticholinergic properties (ACBC1), with a mean (±SD) ACB score of 4.5 (±3.0) (maximum 16). Of those reporting anticholinergic exposure (n=527), 41.3 % (217) reported an ACB score o fC5. Antipsychotics accounted for 36.4 % of the total cumulative ACB score followed by anticholinergics (16 %) and antidepressants (10.8 %). The most frequently reported medicine with anticholinergic activity was carbamazepine 16.8 % (127). The most frequently reported medicine with high anticholinergic activity (ACB 3) was olanzapine13.4 % (101). There was a significant association between higher anti-cholinergic exposure and multimorbidity, particularly mental health morbidity, and some anticholinergic adverse effects such as constipation and day-time drowsiness but not self-rated health.Conclusion: Using simple cumulative measures proved an effective means to capture total burden and helped establish that anticholinergic exposure in the study population was high. The finding highlights the need for comprehensive reviews of medications.

UR - http://link.springer.com/article/10.1007%2Fs11845-014-1177-1

U2 - 10.1007/s11845-014-1177-1

DO - 10.1007/s11845-014-1177-1

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O'Dwyer M, Belton A, Peklar J, Maidment I, McCallon P, McCarron M et al. Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects. 2014. Paper presented at IGS 62nd Annual and Scientific Meeting Science for Healthy & Active Ageing, Galway, Ireland. https://doi.org/10.1007/s11845-014-1177-1