Safety of anticholinergic medications in the elderly: anticholinergic burden and lower urinary tract symptoms (LUTS)

Lisa G. Pont, J. T. H. (Yannick) Nielen, Andrew McLachlan, Danijela Gnjidic, Lewis Chan, Robert Cumming, Katja Taxis

Research output: Contribution to journalMeeting abstractpeer-review


Background: Lower Urinary Tract Symptoms (LUTS)are a significant health issue for the elderly yet little isknown about the clinical relevance of anticholinergic medication use on urinary function. Objectives: To explore the relationship between anticholinergic burden and urinary outcomes (LUTS) in a cohort of community dwelling older men. Methods: A cross sectional survey of baseline data from a longitudinal cohort of 1705 men aged over 70 years resident in the Sydney metropolitan area was conducted. Medication use (prescription and non prescription) andurinary outcomes data (frequency, nocturia, incontinence, post-void residual (PVR) volume, overall LUTS severity and urinary quality of life (UQoL)) was collected during scheduled clinic visits. Anticholinergic burden was assessed using 4 scales (Anticholinergic Cognitive Burden scale (ACB), Anticholinergic Drug burden Scale (ADS), Anticholinergic Risk Scale (ARS), Anticholinergic component of the Drug Burden Index (DBI-A)). Ordinal regression with adjusted parameter estimates was used to compare urinary outcomes with each scale. Results: The mean participant age was 76.9 (±5.5) years. Most participants were using at least one medication. With the exception of the ADS and the ACB (κ = 0.629) agreement between scales to categorize anticholinergic burden was poor (κ<0.3). While an association was found between LUTS severity and increasing anticholinergic burden for all scales the scales varied in their relationship with the individual urinary outcomes. ACB and ADS demonstrated a relationship with increased frequency (ACB: B= 0.427, p = 0.002, ADS: B= 0.350, p = 0.005), ARS and ADS showed an increase in PVR (ARS:B= 0.543, p = 0.043, ADS: B= 0.487, p = 0.022). No relationship between anticholinergic use and nocturia was observed for any scale. Conclusions: Agreement between commonly used scales to measure anticholinergic burden was lacking with respect to urinary function. However, in general, increased anticholinergic burden was associated with poorer outcomes of urinary function in a cohort of older men, highlighting the need for caution when using these medications in the elderly.
Original languageEnglish
Article number362
Pages (from-to)191
Number of pages1
JournalPharmacoepidemiology and Drug Safety
Issue numberS1
Publication statusPublished - Oct 2014
Externally publishedYes
Event30th International Conference on Pharmacoepidemiology and Therapeutic Risk Management - Taipei, Taiwan
Duration: 24 Oct 201427 Oct 2014


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