Patient centered deprescirbing in older adults by general practitioners

Tom Vermeulen, Kris Van Den Broeck

Keywords: Anticholinergic, sedative, medication, deprescribing, cognition, mental wellbeing

Background:

Medication has a greater risk of side effects in older adults due to altered physiology, pharmacokinetics and pharmacodynamics. Nearly 9% of hospital admissions of older adults are officially attributed to side effects of medication (Doherty, Shahid et al. 2022, Chen, Liu et al. 2023). The cause of admission is often a fall, urinary tract infection or delirium.

Research questions:

1. Is a high anticholinergic and sedative load predictive for poor clinical outcomes (cognitive deterioration, falls, hospital admission or transition to long term care facilities)?
2. Is deprescribing by in general practice feasable?
3. Does a lower anticholinergic and sedative load benefit the patient (e.g. higher mental wellbeing and cognitive performance)?

Method:

A pre-post design is conducted with measures on:
- cognition
- depressive and psychotic symptomatology
- anticholinergic and sedative load
In older adults aged 80+

Results:

Results of our pilot study (Vermeulen et al., 2024):
On average we see a score of 1.67 on the ACB and a score of 0.87 on the DBI. The anticholinergic load in the ACB is mainly determined by antipsychotics (β = .647, p < 0.001), in the DBI we see an influence of all medications with anticholinergic properties (F = 6.764, p < 0.001). A risk score on the DBI has a statistically significant correlation with experiencing a urinary tract infection (F = 5.877, p = 0.018). This influence remains significant after adjusting for covariates.

Conclusions:

Deprescribing in general practice could be benificial in preventing poor clinical outcomes in older adults aged 80+. Pre-post results will be discussed in detail.

Points for discussion:

Is anticholinergic and sedative load of medication schemes known in general practice

Can a tool be usefull in calculating the anticholnergic and sedative load and ginving recommendations on deprescribing

Are there opportunities for an interdisciplinary non-pharmacological approach to mental wellbeing in older adults