Discussion
This study investigated the association between anticholinergic drug use and HRQoL in community-dwelling older adults with dementia. The study found that among older adults with dementia anticholinergic drug use significantly reduced PCS compared with nonusers, but no association was found between anticholinergic drug use and MCS. This is consistent with a previous study by Ness et al., which found that the use of anticholinergic drugs, specifically tricyclic antidepressants and agents for urinary incontinence, was associated with poorer HRQoL among a sample of older community-dwelling veterans. Lampela et al. also found an association between anticholinergic drugs and activities of daily living.
The study did not find a significant relationship between anticholinergic drug use and MCS in dementia. Lampela et al. did find associations with instrumental activities of daily living, but it included all older patients. Patients with dementia have pre-existing impaired cognitive functioning. The extent of the effect of anticholinergic drugs on MCS may not be large enough or the MCS of SF-12 may not be sensitive enough to the effects of anticholinergic drug effects. More research is needed to address the cognitive effects of anticholinergic drugs in dementia using better cognitive performance scales. In addition to baseline HRQoL, the use of cholinesterase inhibitors had a positive effect on MCS. The significance of these variables in the regression model strengthens the analytical framework used to examine the effect on HRQoL.
Overall, the study findings suggest that prescribers should consider HRQoL implications when prescribing anticholinergic agents to older adults with dementia. Available evidence indicates that increase in the number of medications taken by older adults increases the risk of using inappropriate medications. Quality of care indicators such as the AGS Beers Criteria, which are used to assess the quality of prescribing medications in the older adult population, suggest the need to avoid anticholinergic drugs in older adults. Hence, there is a need to optimize the prescription of anticholinergic drugs in older adults. The AGS Beers Criteria also recommend the use of safer alternatives or nonpharmacologic approaches in place of anticholinergic drugs and the prescription of drugs without anticholinergic adverse effects, whenever possible.