Abstract
Introduction
Assessment of pharmacotherapy quality in older adults relies on indicators such as polypharmacy and anticholinergic burden. This study aimed to investigate the correlation between polypharmacy and various anticholinergic burden scales in an elderly patient population.
Methods
This study was conducted at a psychiatry outpatient clinic at AIIMS, Rishikesh, India, from December 2021 to March 2023. Elderly patients (aged ≥ 60 years) who were on at least one psychotropic drug and had a primary working diagnosis of psychiatric illness were included. All psychotropic drugs, including antidepressants, antipsychotics, mood stabilizers, and hypnotics, were evaluated. Anticholinergic burden scales were calculated by the respective tools. Univariate analysis was adopted to determine the factors that may affect polypharmacy.
Results
The study included 1165 elderly patients aged ≥ 60 years. The prevalence of polypharmacy was 20.43%. The most common medications prescribed were clonazepam (61.8%), an anxiolytic; escitalopram (25.52%), an antidepressant; and risperidone (26.14%), an antipsychotic. In terms of hypnotic and sedative medications, 51.92% of the patients were prescribed zolpidem. The strongest association with polypharmacy was observed for the Anticholinergic Load Scale (ALS), with an odds ratio of 4.3 (p < 0.001).
Conclusion
The anticholinergic burden in this cohort of elderly psychiatry patients was high, with 95.1% experiencing a significant burden. Adverse drug events and anticholinergic burden scales were positively associated with polypharmacy, with a stronger correlation between polypharmacy and ALS scores than with other anticholinergic burden scales in older adults.