Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE credits
The extent of drugs with anticholinergic effects among elderly patients at a specialist memory clinic in Ängelholm
Author: Thomasson E.
Supervisor: Andersson E.
Examiner: Nielsen. E
Master of Clinical Pharmacy 2015
Institute: Department of Pharmaceutical Biosciences, Division of Pharmacokinetics and Drug Therapy, Faculty of Pharmacy, Uppsala University, Sweden
Background and objective: Drugs with anticholinergic properties may cause side effects such as impaired memory function and confusion, which older patients are generally more sensitive to compared to younger patients. The main objective of this study was to investigate the extent of anticholinergic drugs, with a Swedish version of the Anticholinergic Cognitive Burden scale (ACB), among older patients in a specialist memory clinic, in Ängelholm who have had a medication reconciliation conducted by a pharmacist.
Study design: Retrospective review of medical records. The ACB-scale was applied on patients’ medical records and Excel 2010 was used to analyze data. Chi-square tests were mainly used to investigate whether there were any differences in background variables between patients with 0-2 in ACB-score and 3 or more in ACB-score. To analyze possible differences in number of drugs between the two study groups Mann-Whitney U test was used.
Setting: The specialist memory clinic in Ängelholm.
Main outcome measures: ACB-score.
Results: In the studied population (150 patients), 27% of the patients had an ACB-score ≥3 (which by definition is clinically significant). Differences were seen in background variables (sex, multidose dispensed drugs, psychiatric disease, cardiovascular disease, urological/gynecological disease, diabetes, number of drugs) between those who had 0-2 points and ≥3 points, measured with ACB. The most common drugs within ACB=1 (metoprolol, furosemide, warfarin) occurred in a greater proportion of patients in ACB≥3 compared to ACB=0-2. For ACB=2 the most common drugs were amantadine and carbamazepine. Carbamazepine occurred in a greater proportion of patients in ACB≥3. Solifenacin, amitriptyline, clemastine and olanzapine were the most common drugs in ACB=3.
Conclusions: Additional information and knowledge about the effects of anticholinergic drugs may be beneficial in primary care. The Swedish version of the ACB may, after further review, be helpful in the assessment of patients' drug therapy.
2015. , 21 p.