Alzheimer disease and associated disorders · 2025
Prescription Trends of Potentially Inappropriate Medications and Anticholinergics in Ambulatory Older Adults With and Without Dementia: A Repeated Cross-sectional Analysis at a Tertiary Medical Center in Taiwan.
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Yuan Yu-Ying, Chen Miao-Ting, Liang Chih-Kuang
Аннотация
OBJECTIVE: This study evaluates trends in the use of potentially inappropriate medications (PIMs) and anticholinergic drugs among older adults with and without dementia to enhance medication safety and health care quality.
METHODS: This retrospective repeated cross-sectional study analyzed data from outpatients aged ≥65 years at a medical center in Taiwan from 2018 to 2022. Patients were classified annually by dementia status using ICD-10 codes. PIMs were identified according to the 2019 Beers Criteria, and anticholinergics were identified via the Anticholinergic Cognitive Burden Scale. Trends were analyzed using generalized estimating equations, adjusting for sex, age, Charlson Comorbidity Index, and polypharmacy. Adjusted odds ratios (aORs) with 95% CIs were reported, using 2018 as the reference.
RESULTS: By 2022, PIM use significantly declined in both dementia (aOR 0.91, 95% CI: 0.86-0.97) and nondementia groups (aOR 0.88, 95% CI: 0.86-0.90). Anticholinergic use declined in nondementia patients (aOR 0.80, 95% CI: 0.78-0.83) but remained stable in those with dementia (aOR 0.99, 95% CI: 0.93-1.06). Use of antipsychotics and proton pump inhibitors increased in both groups, while prescribing of ergoloid mesylates, benzodiazepines, and skeletal muscle relaxants declined.
CONCLUSION: PIM use declined overall, but anticholinergic use remained high in older adults with dementia. These findings highlight the need for targeted strategies to reduce inappropriate prescribing, particularly for those with cognitive impairment. Future efforts should emphasize safer deprescribing practices in this vulnerable population.
METHODS: This retrospective repeated cross-sectional study analyzed data from outpatients aged ≥65 years at a medical center in Taiwan from 2018 to 2022. Patients were classified annually by dementia status using ICD-10 codes. PIMs were identified according to the 2019 Beers Criteria, and anticholinergics were identified via the Anticholinergic Cognitive Burden Scale. Trends were analyzed using generalized estimating equations, adjusting for sex, age, Charlson Comorbidity Index, and polypharmacy. Adjusted odds ratios (aORs) with 95% CIs were reported, using 2018 as the reference.
RESULTS: By 2022, PIM use significantly declined in both dementia (aOR 0.91, 95% CI: 0.86-0.97) and nondementia groups (aOR 0.88, 95% CI: 0.86-0.90). Anticholinergic use declined in nondementia patients (aOR 0.80, 95% CI: 0.78-0.83) but remained stable in those with dementia (aOR 0.99, 95% CI: 0.93-1.06). Use of antipsychotics and proton pump inhibitors increased in both groups, while prescribing of ergoloid mesylates, benzodiazepines, and skeletal muscle relaxants declined.
CONCLUSION: PIM use declined overall, but anticholinergic use remained high in older adults with dementia. These findings highlight the need for targeted strategies to reduce inappropriate prescribing, particularly for those with cognitive impairment. Future efforts should emphasize safer deprescribing practices in this vulnerable population.