Drug Side Effect Linked to Increased Health Risks for Over 65s

Side effects from many commonly used drugs—both prescription and over the counter—increase the risk of cognitive impairment and even death in older people, according to a groundbreaking study published in the Journal of the American Geriatrics Society.
Drug Side Effect Linked to Increased Health Risks for Over 65s
6/28/2011
Updated:
7/8/2011

Side effects from many commonly used drugs—both prescription and over the counter—increase the risk of cognitive impairment and even death in older people, according to a groundbreaking study published in the Journal of the American Geriatrics Society.

The long-term research study, led by the University of East Anglia (UEA) in the U.K., is the first of its kind to provide a systematic examination of “anticholinergic activity,” a known side effect of many pharmaceutical and over the counter drugs that affects the brain by blocking a key neurotransmitter called acetylcholine.

Drugs with some degree of anticholinergic effect are wide-ranging, the study found, and many are prescribed to already heavily medicated older people. They include a variety of anti-depressants, tranquilizers, bladder medications, heart medications, painkillers such as codeine, and medications for asthma and epilepsy.

The research was undertaken as part of a larger study in to investigate the risk factors leading to dementia.

Lead author Dr. Chris Fox, clinical senior lecturer at UEA’s Norwich Medical School, has a cautionary message for health professionals.

“Clinicians should conduct regular reviews of the medication taken by their older patients, both prescribed and over the counter, and wherever possible avoid prescribing multiple drugs with anticholinergic effects,” Fox says.

More than 13,000 men and women aged 65 and over from across the U.K. were included in the two-year study. Around half were found to use a medication with potential anticholinergic properties.

Those who were older, with lower income, and a variety of health problems were found to be most likely to take anticholinergic drugs. The study also found the increased risks from the drugs to be cumulative based on the number taken.

“Our findings make it clear that clinicians need to review the cumulative anticholinergic burden in people presenting with cognitive impairment to determine if the drugs are causing decline in mental status,” says Dr Malaz Boustani, associate professor of medicine at Indiana University.

“Every clinician has the duty to protect the brains of their patients and every patient needs to bring over the counter and prescription drugs to their doctor’s appointment for a comprehensive review.”

Boustani reviews the benefits and harms of anticholinergic medications with patients at the Wishard Healthy Aging Brain Center in Indianapolis.

Of the many possible causes of dementia, the link to prescription drugs has never been systematically explored until the UEA study.

“Further research must now be undertaken to understand possible reasons for this link and, in particular, whether and how the anticholinergic drugs might cause the increased mortality,” Fox says.

“In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their family doctor or their pharmacist.”