Antimuscarinics in Older People: Dry Mouth and Beyond.

Many common prescription and over-the-counter medications have antimuscarinic effects. Antimuscarinics are a well recognized cause of dry mouth, with potential to cause other physical and cognitive adverse effects. A comprehensive medication review in a patient presenting with dry mouth can lead to overall health improvements. Scoring systems can be helpful in identifying antimuscarinic drugs and their adverse effects. CPD/Clinical Relevance: Antimuscarinic drug use is prevalent and a common cause of dry mouth. Older people are particularly susceptible to antimuscarinic adverse effects.

Associations between different measures of anticholinergic drug exposure and Barthel Index in older hospitalized patients.

OBJECTIVE: To compare associations between four measures of anticholinergic exposure (anticholinergic risk scale, ARS; anticholinergic drug burden, DBAC; number and use versus no use of anticholinergic drugs), Barthel Index (BI, physical function) and Abbreviated Mental Test (AMT, cognitive function) on admission in older hospitalized patients. METHODS: Prospective observational study of a consecutive series of 271 older patients (age 83 ± 7 years) from community-dwelling and institutionalized settings, admitted to an acute geriatric admission unit between 28 September 2011 and 18 December 2011. The main outcome measures were BI quartiles (primary outcome) and AMT (secondary outcome) on admission. RESULTS: Anticholinergic prevalence was 47%. Multinomial logistic regression showed higher DBAC was associated with a greater risk of being in the lower BI quartiles versus highest BI quartile (Q4). This risk was significant for Q3 (p = 0.04) and Q2 (p = 0.02) but not for Q1 (p = 0.06). A greater number of anticholinergic drugs was associated with a higher risk of being in Q2 (p = 0.02). This risk was not significant for either Q3 (p = 0.10) or Q1 (p = 0.06). No significant associations were observed either with use of anticholinergic medication or with ARS and BI quartiles. AMT did not show independent associations with any of the four measures of anticholinergic exposure. CONCLUSION: In older hospitalized patients, DBAC and some crude measures of anticholinergic exposure, but not ARS, showed independent associations with lower BI, but not AMT. These results highlight differences between various measures of anticholinergic drug exposure when studying their associations with functional status.

Association between prescribing of antimuscarinic drugs and antimuscarinic adverse effects in older people.

Many commonly prescribed medications have antimuscarinic side effects. These can be severe and disabling, but it is not always possible to predict which patients will suffer these effects. The development of practical tools that predict the likelihood of adverse drug reactions would aid rational prescribing, thereby improving patient safety and outcomes. Avoiding predictable adverse drug reactions would also make significant cost savings. This paper discusses the current knowledge on the association between the prescribing of antimuscarinic drugs and adverse outcomes, and proposes novel ways to improve trial design, and data collection and interpretation in order to better identify those patients at the highest risk of antimuscarinic side effects.

Genetic determinants of ageing processes and diseases in later life.

OBJECTIVE: To investigate the role of genetic factors in diseases of later life. METHODS: Review of literature relevant to the role of genetic factors in variation of incidence of age-related diseases of later life using Medline, Web of Science, to search publications in English since 1980 and citations found in relevant publications. RESULTS: The identity of ageing and longevity genes remains unknown despite lively interest in lipoprotein metabolism, genomic instability, oxidative stress, cellular response to damage, inflammatory processes, insulin/IGF1-signalling and Sirtuins. Genes involved in lifespan appear remarkably conserved across species but genes that convey increased susceptibility to specific age-dependent diseases are not yet identified. CONCLUSION: Individual differences in rates of ageing and incidence of the common diseases of later life require explanation. The Sirtuins and the field of epigenetics are emerging as potentially informative research priorities. Further research includes the development of biomarkers and a greater understanding of the interaction between genes and the environment. The hypothetical treatment of ageing could retard or prevent age-associated diseases resulting in widespread health, social and economic benefit.