DOI QR코드

DOI QR Code

Impacts of Pharmacist-involved Multidisciplinary Geriatric Team Services on Reducing Anticholinergic Burden

다학제 팀의료에 의한 노인의료센터 입원환자의 항콜린약물부담 감소효과 분석

  • Lee, Juhye (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Park, Kayoung (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Suh, Yewon (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Lee, Junghwa (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Lee, Eunsook (Department of Pharmacy, Seoul National University Bundang Hospital) ;
  • Lee, Euni (College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University) ;
  • Choi, Jung-Yeon (Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Kim, Kwang-Il (Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Lee, Ju-Yeun (College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University)
  • 이주혜 (분당서울대학교병원 약제부) ;
  • 박가영 (분당서울대학교병원 약제부) ;
  • 서예원 (분당서울대학교병원 약제부) ;
  • 이정화 (분당서울대학교병원 약제부) ;
  • 이은숙 (분당서울대학교병원 약제부) ;
  • 김은경 (서울대학교 약학대학) ;
  • 최정연 (분당서울대학교병원 노인병내과) ;
  • 김광일 (분당서울대학교병원 노인병내과) ;
  • 이주연 (서울대학교 약학대학)
  • Received : 2020.03.14
  • Accepted : 2020.06.02
  • Published : 2020.06.30

Abstract

Background: Reducing the total anticholinergic burden (AB) in older adults is recommended owing to the several peripheral and central adverse effects. This study aimed to identify the AB status of patients admitted to geriatric centers for assessing the influence of the pharmacist-involved multidisciplinary geriatric team care on reducing the AB. Methods: We retrospectively reviewed the medical records of 328 older patients hospitalized in geriatric centers from July 1, 2018 to June 30, 2019, who received comprehensive geriatric assessment and pharmaceutical interventions from a multidisciplinary geriatric team. We measured the total AB scores for the medications at the time of admission and upon hospital discharge using the Korean Anticholinergic Burden Scale (KABS). The pre-admission factors associated with high AB (KABS score ≥3) at the time of admission were identified. Results: The proportion of patients with high AB significantly decreased from 41.8% (136/328) at the time of admission to 25.0% (82/328) on discharge (p<0.001). The pre-admission AB of patients transferred from skilled nursing facilities (odds ratio[OR]: 2.85, 95% CI: 1.26-3.75), taking more than 10 medications (OR: 3.70, 95% CI: 1.55-8.82), suffering from delirium (OR: 2.80, 95% CI: 1.04-7.50), or depression (OR: 2.78, 95% CI: 1.04-7.41) were significantly high. Antipsychotics were the most frequent classes of drugs that contributed to the total KABS score at the time of admission, followed by antihistamines. Conclusions: This study demonstrated that the multidisciplinary teams for geriatric care are effective at reducing AB in older adults. The factors associated with high AB should be considered when targeting pharmaceutical care in geriatric individuals.

Keywords

References

  1. Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol 2006;46:1481-6. https://doi.org/10.1177/0091270006292126
  2. Lechevallier-Michel N, Molimard M, Dartigues JF, Fabrigoule C, Fourrier-Reglat A. Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID Study. Br J Clin Pharmacol 2005;59:143-51. https://doi.org/10.1111/j.1365-2125.2004.02232.x
  3. Landi F, Russo A, Liperoti R, et al. Anticholinergic drugs and physical function among frail elderly population. Clin Pharmacol Ther 2007;81:235-41.
  4. Corsonello A, Pedone C, Incalzi RA. Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions. Curr Med Chem 2010;17:571-84. https://doi.org/10.2174/092986710790416326
  5. Gurwitz JH. Polypharmacy: a new paradigm for quality drug therapy in the elderly? Arch Intern Med 2004;164:1957-9. https://doi.org/10.1001/archinte.164.18.1957
  6. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother 2007;5:345-51. https://doi.org/10.1016/j.amjopharm.2007.12.002
  7. Koh Y, Kutty FB, Li SC. Drug-related problems in hospitalized patients on polypharmacy: the influence of age and gender. Ther Clin Risk Manag 2005;1:39-48. https://doi.org/10.2147/tcrm.1.1.39.53597
  8. Lund BC, Carnahan RM, Egge JA, Chrischilles EA, Kaboli PJ. Inappropriate prescribing predicts adverse drug events in older adults. Ann Pharmacother 2010;44:957-63. https://doi.org/10.1345/aph.1M657
  9. Duran CE, Azermai M, Vander Stichele R. Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol 2013;69:1485-96. https://doi.org/10.1007/s00228-013-1499-3
  10. Boustani M, Campbell N, Munger S, Maidment I, Fox C. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health 2008;4:311-20. https://doi.org/10.2217/1745509X.4.3.311
  11. Campbell NL, Maidment I, Fox C, et al. The 2012 update to the anticholinergic cognitive burden scale. J Am Geriatr Soc 2013; 61:S142-3.
  12. Jun K, Hwang S, Ah YM, Suh Y, Lee JY. Development of an Anticholinergic Burden Scale specific for Korean older adults. Geriatr Gerontol Int 2019;19:628-34. https://doi.org/10.1111/ggi.13680
  13. Rankin A, Cadogan CA, Patterson SM, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2018;9:Cd008165.
  14. Brown W, Maack B, Mehling M. Medication therapy management: teaming with pharmacists for improved patient care. JAAPA 2013;26:40-3.
  15. De Vreese LP, Mantesso U, De Bastiani E, Marangoni A, Weger E, Gomiero T. Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter crosssectional study. PLOS ONE 2018;13:e0205897. https://doi.org/10.1371/journal.pone.0205897
  16. Kumpula EK, Bell JS, Soini H, Pitkälä KH. Anticholinergic drug use and mortality among residents of long-term care facilities: a prospective cohort study. J Clin Pharmacol 2011;51:256-63. https://doi.org/10.1177/0091270010368410
  17. Parkinson L, Magin PJ, Thomson A, et al. Anticholinergic burden in older women: not seeing the wood for the trees? Med J Aust 2015;202:91-4. https://doi.org/10.5694/mja14.00336
  18. Lowry E, Woodman RJ, Soiza RL, Mangoni AA. Clinical and demographic factors associated with antimuscarinic medication use in older hospitalized patients. Hosp Pract (1995) 2011;39:30-6. https://doi.org/10.3810/hp.2011.02.371
  19. Tay HS, Soiza RL, Mangoni AA. Minimizing anticholinergic drug prescribing in older hospitalized patients: a full audit cycle. Ther Adv Drug Saf 2014;5:121-8. https://doi.org/10.1177/2042098614523638
  20. Moga DC, Abner EL, Rigsby DN, et al. Optimizing medication appropriateness in older adults: a randomized clinical interventional trial to decrease anticholinergic burden. Alzheimers Res Ther 2017;9:36.
  21. By the 2019 American Geriatrics Society Beers Criteria$^{(R)}$ Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria (R) for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019;67:674-94. https://doi.org/10.1111/jgs.15767