Abstract
Anticholinergic drugs are used frequently by older adults despite their sub-optimal adverse effect characteristics. 126 medication profiles of patients who attended the local Geriatric Day Hospital/Falls Clinic program of the Nova Scotia Health Authority in Halifax, Nova Scotia, Canada between January and June 2018 were reviewed. Comparisons were made in the key areas of total number of medications and anticholinergic drug burden using 2 risk scores - Anticholinergic Cognitive Burden (ACB) and Drug Burden Index (DBI) - at the time of admission to the program and at completion. The mean number of medications before the program was 9.84 versus 9.50 at completion. Both ACB and DBI scores showed improvement at program completion as compared to admission, with the mean ACB score falling from 1.44 to 1.32, and the mean DBI score decreasing from 0.63 to 0.62. Although these changes were modest, this review demonstrates the importance of thorough medication scrutiny at settings such as geriatric day hospitals, with possible benefits of decreased anticholinergic burden translating into a reduction in medication-associated hazards such as falls, cognitive impairment and functional decline. Qualitative analysis of charts in this study showed that the most common obstacle to acceptance of medication changes by older adults appears to be a lack of motivation to do so and the erroneous belief that they are deriving ongoing benefit from a particular drug that in reality may be more harmful than beneficial. Success in reducing dangerous medications may therefore lie in better education and counseling of older adults.