Falls, Fractures Among OAs Linked to Anticholinergic Exposure

Researchers analyzed the relationship between health care resource utilization (HCRU) and anticholinergic (ACH) polypharmacy with falls and fractures in Medicare Advantage prescription drug (MAPD) plan beneficiaries. Findings were recently presented at AMCP 2022 in Chicago, IL.

To identify MAPD patients aged 65 to 89 years who were dispensed an ACH medication with a score of 2 or 3 on the Anticholinergic Cognitive Burden (ACB) Scale in 2015, study authors utilized the Humana Research Database. Continuous enrollment 12 months pre-index and 24 months post-index marked patients eligible.

Researchers examined time-varying ACH exposure for each follow-up day and reported ≥30 consecutive days of ≥2 ACH medications defined ACH polypharmacy and determined follow-up years 1 and 2.

For the study researchers identified 186,275 ACH therapy users with 69.8% female and a mean age of 74.3 years. Researchers also reported that of the cohort less than 10% were ACH polypharmacy users in either follow-up year.

Furthermore, twice the utilization of anticonvulsants, antidepressants, urinary incontinence drugs, and antipsychotics were identified among ACH polypharmacy users compared to nonusers.

“As exposure to number of ACH medications increased (1, 2, 3, ≥4), there was a linear increase in IRs for inpatient admissions and emergency department visits (both all-cause and cognition-related), and falls/fractures,” wrote researchers. “Compared to periods of no ACH exposure, exposure to periods of ≥4 ACHs were associated with twice the incidence of inpatient admissions, ED visits, and falls/fractures.”

According to study authors, during high-intensity exposure the most common ACHs dispensed were Meclizine, Paroxetine, and Oxybutynin.

“Deprescribing and minimizing exposure of ACHs in elderly patients’ may result in potential reductions in falls/fractures and HCRU, with benefits to utilization outcomes and overall health care costs,” concluded researchers.

Reference:
Xu Y, Poonawalla I, Gaddy R, et al. Anticholinergic exposure and its association with falls and fractures and health care resource utilization. Poster presented at: AMCP 2022; March 29-April 1, 2022; Chicago, IL.