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Ten‐Year Trajectory of Potentially Inappropriate Medications in Very Old Women: Importance of Cognitive Status
Author(s) -
Koyama Alain,
Steinman Michael,
Ensrud Kristine,
Hillier Teresa A.,
Yaffe Kristine
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12093
Subject(s) - medicine , anticholinergic , dementia , cognition , beers criteria , cohort , polypharmacy , longitudinal study , cohort study , gerontology , population , cognitive decline , physical therapy , pediatrics , psychiatry , disease , environmental health , pathology
Objectives To determine which older adults tend to receive potentially inappropriate medications ( PIM s), how this may differ according to cognitive status, and how the trajectories of PIM use change over time. Design Ten‐year longitudinal cohort study. Setting Three clinical sites in the U nited S tates. Participants One thousand four hundred eighty‐four community‐dwelling women aged 75 and older. Measurements At follow‐up, cognitive status was ascertained and classified as normal, mild cognitive impairment ( MCI ), or dementia. Beers 2003 criteria and other literature were used to identify PIM s from detailed medication inventory performed at three time points. Anticholinergic load was measured using the A nticholinergic C ognitive B urden S cale ( ACB ), which assigns medications a value from 0 to 3 depending on anticholinergic properties. Results At baseline, 23.9% of women were taking at least one PIM and the mean ± SD ACB score was 1.41 ± 1.69. The most frequently reported PIM s were anticholinergics (15.2%), benzodiazepines (8.6%), and antispasmodics (8.0%). Over 10 years, PIM use increased for women with dementia (24.9–33.1%; P = .02) but remained fairly constant for women with MCI (23.9–23.0%; P = .84) and normal cognitive status (22.2–19.8%; P = .17). Mean ACB score increased significantly ( P < .001) over time for all groups (dementia: 1.28–2.05; MCI : 0.98–1.66; normal: 0.99–1.48). Conclusion PIM use and anticholinergic load in a community‐dwelling population of older women was high, especially in women who later developed dementia. Future guidelines should limit PIM use and seek safer alternatives.