79.67%

44.51%

23.08%

8.79%

1.67%

≥5 MEDS 5 -9 MEDS 10 -14 MEDS 15 -19 MEDS ≥20 MEDS

Polypharmacy

37.36%

6.59%

1 ACH ≥1 ACH

PIMs (anticholinergics):Anticholinergic Effect on Cognition Scale.

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29.67%

7.69%

1 ACH ≥1 ACH

PIMs (anticholinergics):Anticholinergic Burden Scale

IntroductionØ The older patient is more likely to be prescribed a

lot of medications (polypharmacy) on account of multi-morbidity and being under the care of several specialists.

Ø Medications are not commonly reviewed for continued indications, altered physiology, adverse events and reactions.

Ø Anticholinergic medications confer added risks of cognitive impairment, delirium, hospitalisation and death.

AimØ To estimate the prevalence of polypharmacy and

Potentially Inappropriate Medications (e.ganticholinergics) in patients referred to the Cognitive Impairment and Dementia Service, Elm Lodge (Ealing West), West London NHS Trust.

MethodsØ All referrals between 01/10/20 and 30/11/20

were screened for medications currently prescribed.

Ø 182 of 193 referrals were included in the study. 11 excluded due to incomplete or unavailable medication records.

Ø The Anticholinergic Effect on Cognition Scale, South London & Maudsley’s (SLAM, UK) tool was used to identify anticholinergic medications, and compared with the Anticholinergic Burden Scale (US).

ResultsØ 79.67% prescribed ≥ 5 medicationsØ 44.51% prescribed ≥ 5-9 medicationsØ 23.08% prescribed ≥ 10 -14 medicationsØ 8.79% prescribed ≥ 15 -19 medicationsØ 1.67% prescribed ≥ 20 medicationsØ 37.36% prescribed an anticholinergic (AEC tool)Ø 29.67% prescribed an anticholinergic (ABS tool)Ø 6.59% prescribed > 1 anticholinergic (AEC Tool)Ø 7.69% prescribed > 1 anticholinergic (ABS Tool)Ø Anticholinergic exposure was broadly similar

between the Anticholinergic Effect on Cognition tool and the Anticholinergic Burden Scale.

ConclusionsØ Polypharmacy and potentially inappropriate

prescribing remain widespread in the older adult population. Anticholinergics are also commonly prescribed, sometimes in combination.

Ø Other classes of Potentially Inappropriate Medications prescribed (including medications no longer needed, and OTCs) also ought to be identified and reviewed.

Ø Polypharmacy and PIMs adversely impact on morbidity and increase mortality rates.

Ø Reduction in anticholinergic burden mayimprove cognition and quality of life.

Ø Pharmacovigilance and regular training are needed across services caring for the older adult..

References• Bishara, et al. The anticholinergic effect on cognition (AEC) scale: Associations with mortality, hospitalisation

and cognitive decline following dementia diagnosis. Alzheimer's Dement., 16: e039357.• Corsonello, et al. Polypharmacy in elderly patients at discharge from the acute care hospital. Ther Clin Risk

Manag. 2007;3(1):197-203. • Maher, et al. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65.

doi:10.1517/14740338.2013.827660

Polypharmacy and Potentially Inappropriate Medications (PIMs) in older adults referred to a Memory Clinic.

Dr Anietie Akpan1, Cornelia Termure1, Issadevi Nellaya1, Dr Bruno De Blaquiere1, Dr Sujoy Mukherjee1

1Older Persons Mental Health, West London NHS Trust (correspondence: anietie.akpan@nhs.net)

Acknowledgements: Channessa Wright (admin support).