Temporal Trends of Anticholinergic Drug Exposure Among Older Adults: A 25-Year Population-Based Study.

IF 3.8 2区医学 Q1 PHARMACOLOGY & PHARMACY

Drug Safety Pub Date : 2025-06-27 DOI:10.1007/s40264-025-01562-5

Amanda Evelo, Silvan Licher, Bruno H Stricker, Loes E Visser, Rikje Ruiter

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Abstract

Background: Exposure to anticholinergic drugs is associated with adverse outcomes, particularly among older adults. Limiting the anticholinergic burden (ACB) among older patients has been advocated for decades, but reliable population-level data on temporal trends are lacking. Here, we estimated the cumulative incidence and incidence rates (IRs) of a cumulative ACB score of three or more (cACB ≥ 3) among older adults in a community-dwelling population and described the changes in IR over the past 25 years.

Methods: Within the population-based Rotterdam Study, pharmacy dispensing records were obtained from 11,038 individuals aged 65+ years from 1996 to 2020. The cACB score was calculated with the Anticholinergic Cognitive Burden Scale and supplemented with drugs on the ACB scale by the Expertisecentre PHarmacotherapy in OldeR people (EPHOR). Age- and sex-specific IRs were calculated, and non-overlapping 5-year episodes were defined to determine time trends in IRs.

Results: The cumulative incidence of a cACB ≥ 3 was 25.3% between 1996 and 2020. Compared with 1996-2000, the IR of cACB ≥ 3 had declined by 54% between the 2016-2022 episode (IR ratio: 0.46, 95% confidence interval (CI): 0.41-0.52). Participants aged 86-90 years had more than 1.5 times the rate of a cACB ≥ 3 compared with participants aged 66-70 years (IR ratio: 1.67, 95% CI 1.46-1.91).

Conclusions: Exposure to anticholinergic drugs has decreased by over 50% between 1996 and 2020 in this population of community-dwelling adults. However, the oldest old had and remained to have the highest risk of a cACB ≥ 3 during our study period. Thus, prescribers and pharmacists should continue to regularly review the prescription of drugs with an ACB, especially among those vulnerable to adverse outcomes.

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老年人抗胆碱能药物暴露的时间趋势：一项基于人群的25年研究。

背景：暴露于抗胆碱能药物与不良后果有关，特别是在老年人中。限制老年患者的抗胆碱能负担（ACB）已经提倡了几十年，但缺乏可靠的人口水平的时间趋势数据。在这里，我们估计了社区居住人群中累积ACB评分为3分或以上（cACB≥3）的老年人的累积发病率和发病率（IRs），并描述了过去25年来IR的变化。方法：在以人群为基础的鹿特丹研究中，从1996年至2020年获得了11038名65岁以上个体的药房调剂记录。ACB评分采用抗胆碱能认知负担量表计算，并辅以老年人药物治疗专家中心（EPHOR） ACB量表上的药物。计算年龄和性别特异性ir，并定义不重叠的5年发作以确定ir的时间趋势。结果：1996 - 2020年间，cACB≥3的累积发病率为25.3%。与1996-2000年相比，2016-2022年期间，cACB≥3的IR下降了54% （IR比：0.46,95%可信区间（CI）： 0.41-0.52）。与66-70岁的参与者相比，86-90岁的参与者cACB≥3的比率超过1.5倍（IR比：1.67,95% CI 1.46-1.91）。结论：1996年至2020年间，该社区居住的成年人暴露于抗胆碱能药物的比例下降了50%以上。然而，在我们的研究期间，年龄最大的老年人的cACB≥3的风险最高。因此，开处方者和药剂师应继续定期审查具有ACB的药物处方，特别是那些容易产生不良后果的药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug Safety 医学-毒理学

CiteScore

7.60

自引率

7.10%

发文量

112

审稿时长

6-12 weeks

期刊介绍： Drug Safety is the official journal of the International Society of Pharmacovigilance. The journal includes: Overviews of contentious or emerging issues. Comprehensive narrative reviews that provide an authoritative source of information on epidemiology, clinical features, prevention and management of adverse effects of individual drugs and drug classes. In-depth benefit-risk assessment of adverse effect and efficacy data for a drug in a defined therapeutic area. Systematic reviews (with or without meta-analyses) that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. Original research articles reporting the results of well-designed studies in disciplines such as pharmacoepidemiology, pharmacovigilance, pharmacology and toxicology, and pharmacogenomics. Editorials and commentaries on topical issues. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Drug Safety Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.