Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-23T15:08:50.805Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of tricyclic antidepressants and other anticholinergic medicines by older Aboriginal Australians: association with negative health outcomes

Published online by Cambridge University Press:  28 September 2020

Karen Mate Open the ORCID record for Karen Mate [Opens in a new window] ,
Karen Kerr ,
Alison Priestley ,
Natasha Weaver ,
Gerald A. Broe ,
Gail Daylight ,
Brian Draper ,
Robert Cumming ,
Hemi Robinson-Kingi  and
Kim Delbaere
...Show all authors
Karen Mate*
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
Karen Kerr
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
Alison Priestley
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
Natasha Weaver
Affiliation:
School of Medicine & Public Health, University of Newcastle, Callaghan, NSW, Australia
Gerald A. Broe
Affiliation:
Neuroscience Research Australia, Randwick, NSW, Australia Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
Gail Daylight
Affiliation:
Neuroscience Research Australia, Randwick, NSW, Australia
Brian Draper
Affiliation:
Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia Department of Old Age Psychiatry, Prince of Wales Hospital, RandwickNSW, Australia
Robert Cumming
Affiliation:
School of Public Health, University of Sydney, Darlington, NSW, Australia
Hemi Robinson-Kingi
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
Kim Delbaere
Affiliation:
Neuroscience Research Australia, Randwick, NSW, Australia Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
Kylie Radford
Affiliation:
Neuroscience Research Australia, Randwick, NSW, Australia Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
*
Correspondence should be addressed to: Dr Karen Mate, School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia. Phone: +61 2 49215983. Email: Karen.Mate@newcastle.edu.au.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Aboriginal and Torres Strait Islander Australians have a relatively high prevalence of multimorbidity requiring treatment with medications. This study examines medication use and anticholinergic burden (ACB) among a cohort of older Aboriginal and Torres Strait Island people.

Method:

This cross-sectional study involving five Aboriginal communities (two in metropolitan Sydney and three on the mid-north coast of New South Wales) used a structured interview process to assess cognition, depression, and activities of daily living for a cohort of older adults (aged 60 years and over). Participants also reported on their health status, medical history, and prescription medications during the interview. ACB was calculated, and its association with adverse health outcomes including cognitive impairment, falls, hospitalization, and depressive symptoms were examined.

Results:

Most participants (95%) were taking at least one regular medication with polypharmacy (≥5 medications) observed in 43% of participants; 12.2% had a significant ACB (≥3) with antidepressants being a major contributor. Anticholinergic medication use was associated with cognitive impairment, recent hospitalization (past 12 months), and depressive symptoms. After controlling for age, sex, and comorbidity, only the presence of depressive symptoms remained significantly associated with the use of anticholinergic medication (odds ratio 2.86; 95% confidence interval 1.48–5.51).

Conclusions:

Clinically significant ACB was common in older Aboriginal Australians and was largely attributable to inappropriate use of tricyclic antidepressants. Greater awareness of medication-related risk factors among both health care professionals and Aboriginal communities can play an important role in improving health and quality of life outcomes.

Keywords

quality of health carecholinergic antagonistsdementiapopulation characteristicsaged
Type
Original Research Article
Information
International Psychogeriatrics , Volume 34 , Special Issue 1: Issue Theme: Varied Angles of Geriatric Depression , January 2022 , pp. 71 - 78
Copyright
© International Psychogeriatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Joint senior authors.

References

Akhtar, A. J., Broe, G. A., Crombie, A., McLean, W. M., Andrews, G. R. and Caird, F. I. (1973). Disability and dependence in the elderly at home. Age and Ageing, 2, 102–111. doi: 10.1093/ageing/2.2.102.CrossRefGoogle ScholarPubMed
American Geriatrics Society Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67, 674–694. doi: 10.1111/jgs.15767.CrossRefGoogle Scholar
Cross, A. J. et al. (2016). Potentially inappropriate medications and anticholinergic burden in older people attending memory clinics in Australia. Drugs & Aging, 33, 37–44. doi: 10.1007/s40266-015-0332-3.CrossRefGoogle ScholarPubMed
Duran, C. E., Azermai, M. and Vander Stichele, R. H. (2013). Systematic review of anticholinergic risk scales in older adults. European Journal of Clinical Pharmacology, 69, 1485–1496. doi: 10.1007/s00228-013-1536-2.CrossRefGoogle ScholarPubMed
Esler, D., Johnston, F., Thomas, D. and Davis, B. (2008). The validity of a depression screening tool modified for use with Aboriginal and Torres Strait Islander people. Australian and New Zealand Journal of Public Health, 32, 317–321. doi: 10.1111/j.1753-6405.2008.00247.x.CrossRefGoogle ScholarPubMed
Fox, C. et al. (2011). Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. Journal of the American Geriatrics Society, 59, 1477–1483. doi: 10.1111/j.1532-5415.2011.03491.x.CrossRefGoogle ScholarPubMed
Gerretsen, P. and Pollock, B. G. (2011). Drugs with anticholinergic properties: a current perspective on use and safety. Expert Opinion on Drug Safety, 10, 751–765. doi: 10.1517/14740338.2011.579899.CrossRefGoogle ScholarPubMed
Gnjidic, D. et al. (2012). Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. Journal of Clinical Epidemiology, 65, 989–995. doi: 10.1016/j.jclinepi.2012.02.018.CrossRefGoogle ScholarPubMed
Green, A. R., Reifler, L. M., Boyd, C. M., Weffald, L. A. and Bayliss, E. A. (2018). Medication profiles of patients with cognitive impairment and high anticholinergic burden. Drugs & Aging, 35, 223–232. doi: 10.1007/s40266-018-0522-x.CrossRefGoogle ScholarPubMed
Halonen, J. I., Koskinen, A., Kouvonen, A., Varje, P., Pirkola, S. and Vaananen, A. (2018). Distinctive use of newer and older antidepressants in major geographical areas: a nationally representative register-based study. Journal of Affective Disorders, 229, 358–363. doi: 10.1016/j.jad.2017.12.102.CrossRefGoogle ScholarPubMed
Hamrosi, K., Taylor, S. J. and Aslani, P. (2006). Issues with prescribed medications in Aboriginal communities: Aboriginal health workers’ perspectives. Rural and Remote Health, 6, 557. doi: 10.22605/RRH557Google ScholarPubMed
Mate, K. E. et al. (2015). Impact of multiple low-level anticholinergic medications on anticholinergic load of community-dwelling elderly with and without dementia. Drugs & Aging, 32, 159–67. doi: 10.1007/s40266-014-0230-0.CrossRefGoogle ScholarPubMed
McManus, P., Mant, A., Mitchell, P., Britt, H. and Dudley, J. (2003). Use of antidepressants by general practitioners and psychiatrists in Australia. Australian and New Zealand Journal of Psychiatry, 37, 184–189. doi: 10.1046/j.1440-1614.2003.01132.x CrossRefGoogle ScholarPubMed
Mintzer, J. and Burns, A. (2000). Anticholinergic side-effects of drugs in elderly people. Journal of the Royal Society of Medicine, 93, 457–462. doi: 10.1177/014107680009300903.CrossRefGoogle ScholarPubMed
Page, A. et al. (2019). Potentially suboptimal prescribing of medicines for older Aboriginal Australians in remote areas. Medical Journal of Australia, 211(3), 119–125. doi: 10.5694/mja2.50226.CrossRefGoogle ScholarPubMed
Pruckner, N. and Holthoff-Detto, V. (2017). Antidepressant pharmacotherapy in old-age depression-a review and clinical approach. European Journal of Clinical Pharmacology, 73, 661–667. doi: 10.1007/s00228-017-2219-1.CrossRefGoogle ScholarPubMed
Radford, K. et al. (2014). The Koori Growing Old Well Study: investigating aging and dementia in urban Aboriginal Australians. International Psychogeriatrics, 26, 1033–1043. doi: 10.1017/S1041610213002561.CrossRefGoogle ScholarPubMed
Radford, K. et al. (2015a). Prevalence of dementia in urban and regional Aboriginal Australians. Alzheimer’s & Dementia, 11, 271–279. doi: 10.1016/j.jalz.2014.03.007.CrossRefGoogle Scholar
Radford, K. et al. (2015b). Comparison of three cognitive screening tools in older urban and regional Aboriginal Australians. Dementia and Geriatric Cognitive Disorders, 40, 22–32. doi: 10.1159/000377673.CrossRefGoogle Scholar
Randall, D. A., Lujic, S., Havard, A., Eades, S. J. and Jorm, L. (2018). Multimorbidity among Aboriginal people in New South Wales contributes significantly to their higher mortality. Medical Journal of Australia, 209, 19–23. doi: 10.5694/mja17.00878.CrossRefGoogle ScholarPubMed
Richardson, K. et al. (2018). Anticholinergic drugs and risk of dementia: case-control study. The BMJ, 361, k1315. doi: 10.1136/bmj.k1315.CrossRefGoogle ScholarPubMed
Salahudeen, M. S., Duffull, S. B. and Nishtala, P. S. (2015). Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatrics, 15, 31. doi: 10.1186/s12877-015-0029-9.CrossRefGoogle ScholarPubMed
Smith, K. et al. (2008). High prevalence of dementia and cognitive impairment in Indigenous Australians. Neurology, 71, 1470–1473. doi: 10.1212/01.wnl.0000320508.11013.4f.CrossRefGoogle ScholarPubMed
Tannenbaum, C., Paquette, A., Hilmer, S., Holroyd-Leduc, J. and Carnahan, R. (2012). A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine, GABAergic and opioid drugs. Drugs & Aging, 29, 639–658. doi: 10.2165/11633250-000000000-00000.Google ScholarPubMed
Vos, T., Barker, B., Begg, S., Stanley, L. and Lopez, A. D. (2009). Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. International Journal of Epidemiology, 38, 470–477. doi: 10.1093/ije/dyn240.CrossRefGoogle ScholarPubMed
Supplementary material: File

Mate et al. Supplementary Materials

Mate et al. Supplementary Materials

Download Mate et al. Supplementary Materials(File)
File 15.6 KB