OBJECTIVES

Medications with anticholinergic (ACh) properties are known to cause a wide range of adverse clinical outcomes, especially among older adults. This study described prescribing trends from 2010 to 2016 and potential predictors associated with high anticholinergic prescriptions.

METHODS

A pooled (2010-2016) cross-sectional panel of outpatient visits by U.S. older adults (≥65 years old) was constructed from the National Ambulatory Medical Care Survey (NAMCS). ACh burden was identified using the validated Anticholinergic Cognitive Burden Scale (ACB); scores ranging from 0-3 (3: strongest ACh properties). High ACB prescribing (ACB ≥3) was the dependent variable. Temporal trends of high ACB prescribing were described. We used survey-weighted multivariate logistic regression to identify risk factors for high ACB prescribing.

RESULTS

From 2010-2016, the pooled sample represented over 1.8 billion clinic visits nationally. Nearly 1 in 10 (9.8%) outpatient visits, or 25.4 million visits annually, resulted in high anticholinergic prescribing. Adjusted results suggested ACB prescribing was stable until 2013, with a significant downward trend beginning in 2014 (10.7% down to 7.6%, p<0.01). High ACB prescribing was significantly associated with being female (OR=1.53, p<0.01). Psychiatrists (OR=1.83, p<0.01) and urologists (OR=1.40, p<0.01) were more likely to prescribe high ACBs. High ACB prescribing was also associated with neuropathic pain (OR=1.40, p<0.01), other psychiatric disorders (OR=1.60, p<0.01), and increasing number of comorbidities (OR=1.18, p<0.01); ranging from 7% for no comorbidities to 33% for the maximum 12 comorbidities. Dry mouth/blurry vision/fatigue was marginal significant (OR=1.76, p=0.07).

CONCLUSIONS

Overall, nearly 1 in 10 outpatient visits result in high ACB prescribing. ACB prescriptions has slightly decreased. Prescribing rates began to trend downward beginning in 2014. Continued quality improvement efforts are needed to improve prescribing safety in older adults.