Anticholinergic and sedative medications exposure in older patients: a cross-sectional study

Background The Drug Burden Index is a risk assessment tool used to quantify anticholinergic and sedative medications burden of older patients. There have been no previously published reports the exposure of anticholinergic and sedative medications in China. Objective We investigated the prevalence and correlates risk factors of anticholinergic and sedative medications in hospitalized older patients with polypharmacy in China. Settings The Department of Geriatrics in a tertiary care teaching hospital. Methods A retrospective analysis of patient medical records of hospitalized older patients with polypharmacy was undertaken at a large university teaching hospital in China. Polypharmacy was defined as the regular use of more than five medications. Prescribing of anticholinergic and sedative medications was identified using the medication list of the Drug Burden Index, and logistic regression analysis determined associations between drug exposure and independent variables. Main outcome measure Anticholinergic and sedative medications identified by the Drug Burden Index. Results A total of 383 patients were included in this study, with an average age of 82.6 +/- 7.0 years and included 72.9% (279/383) male patients. Of the study participants, 23.8% (91/383) were prescribed anticholinergic and sedative medications. Of the 106 medicines identified by the Drug Burden Index, the most frequently prescribed medications were estazolam in 51.9% (55/106), terazosin in 14.1% (15/106), loratadine in 10.4% (11/106), and cetirizine in 5.7% (6/106); these four medications accounted for 82.1% of the anticholinergic and sedative medications. Drug exposure was associated with age >= 80 years (OR 2.246; 95% CI 1.100-4.586), the number of prescribed medications (OR 1.102; 95% CI 1.018-1.193), and symptoms of insomnia (OR 28.990; 95% CI 14.197-59.200). Conclusions The findings of this study showed that the prevalence of anticholinergic and sedative exposure in hospitalized older patients with polypharmacy in China. The prevalence of exposure of anticholinergic and sedative medications was 23.8%. According to the Drug Burden Index estazolam and terazosin were the most common medications in the sedative or anticholinergic drug class, respectively.