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Two reviewers (M.S.S. and P.S.N.) extracted data onto standardised format based on study population, study design, use of appropriate rating scales to quantify anticholinergic burden and outcome measures. The primary outcomes of interest were functional and cognitive outcomes associated with anticholinergic burden quantified by the expert opinion derived anticholinergic rating scales.
The primary electronic literature search identified a total of 1250 articles from 3 different databases such as Ovid MEDLINE, EMBASE, and PsycINFO. EndNote was used to eliminate duplicates and we considered 932 articles for screening. Out of 932 screened articles based on title and abstract, only 21 were eligible for full-text analysis. From the eligible 21 studies, 14 were excluded on full text analysis according to the set inclusion and exclusion criteria. Hence, in total, 7 studies were included in this review that considered expert opinion/s in the development of the anticholinergic rating scales [ 9, 19, 22- 26]. Figure 1 depicts a flow-diagram of the identification, screening, eligibility and exclusion process. The specialist physicians had worked for a median of 15 years (cohort 1) and 16.5 years (cohort 2) in the tertiary care of patients with SUD. Approximately three out of four participants worked in acute care hospitals, with the remainder working in rehabilitation clinics ( Table 1). Average Overall Harm Cai X, Campbell N, Khan B, Callahan C, Boustani M. Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2013;9(4):377–85.A citation analysis was performed to identify and compare the clinical utility of individual anticholinergic rating scales to quantify anticholinergic burden and to evaluate its association with adverse outcomes (cognitive, functional, mortality) in older people. Studies that used the rating scales for assessing the adverse outcomes in older people are reported in this review.
As a result of these possible limitations, the CSEW is likely to underestimate the level of drug misuse in England and Wales. In the year ending June 2022, 2.7% of adults aged 16 to 59 years and 4.7% of adults aged 16 to 24 years reported last year Class A drug use; a significant decrease from the year ending March 2020 when this was 3.4% and 7.4%, respectively. Powder cocaine: There was no change in the prevalence of last year powder cocaine use for adults aged 16 to 59 years (2.0%) and 16 to 24 years (4.0%) compared with the year ending March 2020. However, levels were higher than the year ending December 1995 when estimates were first recorded. The Misuse of Drugs Act 1971 classifies controlled drugs into three categories (Classes A, B and C), according to the harm that they cause, with Class A drugs considered to be the most harmful. For drugs and their classifications, please see the Home Office List of most commonly encountered drugs currently controlled under the misuse of drugs legislation.The CSEW covers the population living in households in England and Wales; it does not cover the population living in group residences (for example, care homes or student halls of residence) or other institutions, for example, prisons. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Kumpula EK, Bell JS, Soini H, Pitkala KH. Anticholinergic drug use and mortality among residents of long-term care facilities: a prospective cohort study. J Clin Pharmacol. 2011;51(2):256–63. Results: Illicit drugs such as methamphetamine, heroin, cocaine and also alcohol were judged particularly harmful, and new psychoactive drugs (cathinones, synthetic cannabinoids) were ranked among the most harmful substances. Cannabis was ranked in the midrange, on par with benzodiazepines and ketamine—somewhat more favorable compared to the last European survey. Prescribed drugs including opioids (in contrast to the USA, Canada, and Australia) were judged less harmful. NOAs were at the bottom end of the ranking.
Substances such as mephedrone, spice, GBL or GHB, salvia and other emerging substances are collectively known as new psychoactive substances (NPS), often previously referred to as "legal highs". These substances are usually intended to mimic the effects of "traditional" drugs such as cannabis, ecstasy, or cocaine and can come in different forms such as herbal mixtures that are smoked, powders, crystals, tablets, or liquids. Frequent drug user of Psychiatry and Psychotherapy, Faculty of Medicine, Landschaftsverband Rheinland-Hospital Essen, University of Duisburg-Essen, Essen, Germany Campbell N, Perkins A, Hui S, Khan B, Boustani M. Association between prescribing of anticholinergic medications and incident delirium: a cohort study. J Am Geriatr Soc. 2011;59 Suppl 2:S277–81. Medicines with anticholinergic properties are frequently prescribed in the older population for various medical conditions [ 1]. The cumulative effect of taking one or more medicines with anticholinergic properties is referred to as anticholinergic burden [ 2]. The majority of medicines commonly prescribed to older people are not routinely recognised as having anticholinergic activity and empirically physicians prescribe these medicines based on their anticipated therapeutic benefits overlooking the risk of cumulative anticholinergic burden [ 3]. These scales considered various medications and were validated using adverse clinical outcomes. Moreover, they were developed for general populations and applied successfully to administrative data. The research team highlighted the need to develop and validate longitudinal study methodologies that encompass both aspects of anticholinergic treatment. ReferencesAs people age, they accumulate several health conditions, requiring the use of multiple medications (polypharmacy) to treat them. One of the challenges with polypharmacy is the associated increase in anticholinergic exposure to older adults. In addition, several studies suggest an association between anticholinergic burden and declining physical function in older adults. Objective/Purpose The studies involving human participants were reviewed and approved by Ethik-Kommission der Medizinischen Fakultät der Universität Duisburg-Essen. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. Author Contributions of Psychiatry and Psychotherapy University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany Panula J, Puustinen J, Jaatinen P, Vahlberg T, Aarnio P, Kivela SL. Effects of potent anticholinergics, sedatives and antipsychotics on postoperative mortality in elderly patients with hip fracture: a retrospective, population-based study. Drugs Aging. 2009;26(11):963–71.
A systematic literature search was conducted across five electronic databases, EMBASE, CINAHL, PSYCHINFO, Cochrane CENTRAL and MEDLINE, from inception to December 2021, to identify studies on the association of anticholinergic burden with mobility. The search was performed following a strategy that converted concepts in the PECO elements into search terms, focusing on terms most likely to be found in the title and abstracts of the studies. For observational studies, the risk of bias was assessed using the Newcastle Ottawa Scale, and the Cochrane risk of bias tool was used for randomised trials. The GRADE criteria was used to rate confidence in evidence and conclusions. For the meta-analyses, we explored the heterogeneity using the Q test and I 2 test and the publication bias using the funnel plot and Egger’s regression test. The meta-analyses were performed using Jeffreys’s Amazing Statistics Program (JASP). Results Koyama A, Steinman M, Ensrud K, Hillier TA, Yaffe K. Long-term Cognitive and Functional Effects of Potentially Inappropriate Medications in Older Women. J Gerontol A: Biol Med Sci. 2014;69(4):423–9.In 2017, 3,284 drug-related deaths ( DRDs) occurred in Great Britain using the European Monitoring Centre for Drugs and Drug Addiction ( EMCDDA) definition, which is deaths caused directly by the consumption of at least one illicit drug.
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