The aim was to study whether the anticholinergic burden of drugs is related to xerostomia and salivary secretion among community-dwelling elderly people.
Anticholinergic drugs have been shown to be a risk factor for dry mouth, but little is known about the effects of cumulative exposure to anticholinergic drugs measured by anticholinergic burden on salivary secretion or xerostomia.
The study population consisted of 152 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study. The data were collected by interviews and clinical examinations. Anticholinergic burden was determined using the Anticholinergic Drug Scale (ADS). A Poisson regression model with robust error variance was used to estimate relative risks (RR) with 95% confidence intervals (CI 95%).
Participants with a high-anticholinergic burden (ADS = 3) were more likely to have xerostomia (RR: 3.17; CI: 1.44-6.96), low-unstimulated salivary flow (
Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self-reported symptoms in older community-dwelling persons with and without diabetes.
The basic population was comprised of Finnish community-dwelling primary care patients aged 65 and older. Persons with diabetes were identified according to the ICD-10 diagnostic codes from electronic patient records. Two controls adjusted by age and gender were selected for each person with diabetes. This cross-sectional study was based on electronic primary care patient records and a structured health questionnaire. The health questionnaire was returned by 430 (81.6%) persons with diabetes and 654 (73.5%) persons without diabetes. Data on prescribed drugs were obtained from the electronic patient records. Anticholinergic drug use was measured according to the Anticholinergic Risk Scale. The presence and strength of anticholinergic symptoms were asked in the health questionnaire.
The prevalence of anticholinergic drug use was 8.9% in the total study cohort. There were no significant differences in anticholinergic drug use between persons with and without diabetes. There was no consistent association between anticholinergic drug use and self-reported symptoms.
There is no difference in anticholinergic drug use in older community-dwelling persons with and without diabetes. Anticholinergic drug use should be considered individually and monitored carefully.
Many potentially inappropriate drugs prescribed to older people have anticholinergic properties as adverse effects and are therefore potentially harmful. These effects typically include constipation, dry mouth, blurred vision, dizziness and slowing of urination. It has been shown that drugs with anticholinergic properties (DAPs) are associated with cognitive decline and dementia, may contribute to events such as falls, delirium and impulsive behaviour, are associated with self-reported adverse effects and physical impairment, and may even be associated with mortality. However, studies of the prognostic implications of DAPs remain scarce.
To evaluate the impact of DAPs on hospitalization and mortality in older patients with stable cardiovascular disease (CVD).
This was a prospective study with a mean follow-up of 3.3 years involving two study groups: users (n?=?295) and non-users (n?=?105) of DAPs. The participants were 400 community-dwelling older people (aged 75-90 years) with stable CVD participating in a secondary prevention study of CVD (DEBATE) in Helsinki, Finland. The use of DAPs was estimated using definitions from the previous scientific literature. The Charlson Comorbidity Index (CCI) was used to estimate the burden of co-morbidity and the Mini-Mental State Examination test was used to assess cognitive function. The risks in the two study groups for hospital visits, number of days spent in hospital care and mortality were measured from 2000 to the end of 2003.
The unadjusted follow-up mortality was 20.7% and 9.5% among the users and non-users of DAPs, respectively (p?=?0.010). However, the use of DAPs was not a significant predictor of mortality in multivariate analysis after adjustment for age, sex and CCI score (hazard ratio 1.57; 95% CI 0.78, 3.15). The mean?±?SD number of hospital days per person-year was higher in the DAP user group (14.9?±?32.5) than in the non-user group (5.2?±?12.3) [p?
Oral health status is poor and a disregarded health issue among patients with schizophrenia that is associated with the risk for additional social stigmatization and potentially fatal infections.
A historical, prospective database study of dental visits, utilizing the Danish National Patient Registry, of 21,417 patients with ICD-10-diagnosed schizophrenia in the year 2006 and of 18,892 patients for the 3-year period of 2004-2006 was conducted. Multiple logistic regression analyses were used to identify risk factors for lack of dental care.
Only 43% of patients with schizophrenia (9,263/21,417)--compared to an annual dental visit rate of 68% in the general adult Danish population (2,567,634/3,790,446)-visited the dentist within 12 months in 2006 (OR = 2.8; 95% CI, 2.7-2.9; P 50 years were associated with a lower risk for inappropriate dental care.
Patients with schizophrenia visit dentists much less frequently than the general population in the same country. Health professionals should pay more attention to the dental health care of patients with schizophrenia, actively encourage patients to regularly visit the dentist, and establish a formal collaboration with dentists to improve the dental health aspects of this disadvantaged patient group.
To provide guidelines for pharmacotherapy to treat overactive bladder syndrome (OAB).
Pharmacotherapy for OAB includes anticholinergic (antimuscarinic) drugs and vaginal estrogen. Both oral and transdermal anticholinergic preparations are available.
To provide understanding of current available evidence concerning safety and clinical efficacy of pharmacotherapy for OAB; to guide selection of anticholinergic therapy based on individual patient characteristics.
The Cochrane Library and Medline were searched for articles published from 1950 to the present related to individual anticholinergic drugs. Review articles on management of refractory OAB were also examined. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to 2010.
The quality of evidence is rated and recommendations are made using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1).
Anticholinergics are the mainstay of pharmacotherapy for OAB. EVIDENCE for their efficacy is mostly derived from short-term phase III randomized drug trials. Placebo response is strong, and long-term follow-up and patient subjective outcome data are lacking. Care providers need to be well acquainted with the side effects of anticholinergics and select therapy based on individual patient parameters. Recommendations 1. Behavioural management protocols and functional electrical stimulation should be offered in the spectrum of effective primary treatments for overactive bladder syndrome. (I-A) 2. Oral oxybutynin, immediate and extended release, as well as transdermal oxybutynin, may be offered as treatment for overactive bladder syndrome, as they are associated with significant objective clinical improvement at 12 weeks. (I-A) Oxybutynin immediate release has superior cost-effectiveness but more side effects than other anticholinergics. (I-A) Adverse events associated with transdermal oxybutynin are fewer than with oral oxybutynin. (I-A) 3. Tolterodine, immediate and extended release, may be offered as treatment for overactive bladder syndrome, as it is associated with significant objective clinical improvement at 12 weeks. (I-A) 4. Trospium, immediate and extended release, may be offered as treatment for overactive bladder syndrome as it is associated with significant clinical improvement at 12 weeks. (I-A) Trospium is an adequate anticholinergic choice for overactive bladder syndrome patients with pre-existing cognitive impairment (II-B) and for overactive bladder syndrome patients taking concurrent CYP450 inhibitors. (III-B) 5. Solifenacin may be offered as treatment for overactive bladder syndrome, as it is associated with significant objective clinical improvement at 12 weeks. (I-A) Solifenacin may be an adequate anticholinergic choice for elderly overactive bladder syndrome patients or patients with pre-existing cognitive dysfunction. (I-B) 6. Darifenacin may be offered as treatment for overactive bladder syndrome, as it is associated with significant objective clinical improvement at 12 weeks. (I-A) Darifenacin is an adequate anticholinergic choice for overactive bladder syndrome patients with pre-existing cardiac concerns or cognitive dysfunction. (I-B) 7. Overactive bladder syndrome patients should be offered a choice between bladder training, functional electric stimulation, and anticholinergic therapy, as there is no difference in cure rates. Combination therapy does not have a clear advantage over one therapy alone. (I-A) 8. The choice of anticholinergic therapy should be guided by individual patient comorbidities, as objective efficacy of anticholinergic drugs is similar. (I-A) Dose escalation does not improve objective parameters and causes more anticholinergic adverse effects. It is, however, associated with improved subjective outcomes. (I-A) To decrease side effects, switching to a lower dose or using an extended release formulation or a transdermal delivery mechanism should be considered. (I-A) 9. Education on treatment efficacy, realistic expectations, and length of treatment should be offered to patients upon initiation of anticholinergic therapy, as continuation rates for anticholinergic therapy are low. (III-B) 10. Oral or transdermal estrogen supplementation should not be recommended for treatment of overactive bladder syndrome as its effects are comparable to placebo. (I-E) Vaginal estrogen can be suggested for subjective improvements in overactive bladder syndrome symptoms. (III-B) 11. Intravesical botulinum toxin injection and sacral nerve and posterior tibial nerve stimulation are clinically effective options for patients with overactive bladder syndrome unresponsive to conservative options, anticholinergics, or vaginal estrogen. (I-A).
Drugs with anticholinergic properties have harmful effects among frail older people and they may antagonize the effects of cholinesterase inhibitors (ChEIs). However, their association with psychological well-being has not been studied.
To determine (1) the prevalence of the use of anticholinergic drugs, ChEIs, or their combination among older adults in residential care facilities and their association with psychological well-being, and (2) the association of anticholinergic drugs with an individual's psychological well-being.
In 2007, all older adults (N = 1475) living in residential care facilities in the cities of Helsinki and Espoo, Finland, were assessed in a cross-sectional study. A trained nurse retrieved data on demographic factors, regularly administered medications, and diagnoses from medical charts. Psychological well-being was assessed using 6 questions concerning life satisfaction, zest for life, plans for the future, feeling needed, and feeling depressed or lonely, and a psychological well-being score was created (range 0-1).
Residents taking anticholinergic drugs (n = 613) were significantly younger, used more drugs, and were more often on ChEIs compared with nonusers (n = 862). There was no significant difference in Charlson comorbidity index, stage of cognition, or dependence on activities of daily living between the users or nonusers of anticholinergic drugs. The anticholinergic drug users had significantly lower psychological well-being scores compared with the nonusers. Of the participants, 10.7% used ChEIs and anticholinergic drugs concomitantly. In logistic regression analysis where age, sex, comorbidities, and use of ChEIs were used as covariates, lower psychological well-being was associated with the use of anticholinergic drugs (OR 1.40; 95% CI 1.00 to 1.94; p = 0.048).
Concomitant use of anticholinergic drugs and ChEIs is common among older adults. The use of anticholinergic drugs is associated with poor psychological well-being.