UH Professor Probes Risks to Elderly Mental Health from Common Class of Drugs

Aparasu Receives Nearly $1M to Study Anticholingeric Use in Nursing Home Patients with Depression

Professor Rajender R. Aparasu has received a federal research grant to determine the risks of demnentia, cognitive decline, falls and fractures, and death associated with the use of a common class of drugs called anticholinergics in elderly nursing home patients with depression.

04-19-13 Houston -- UHCOP Professor Rajender Aparasu, Ph.D., FAPhA, is evaluating millions of medical claims to determine if use of a common class of drugs increases the risk of cognitive decline, dementia, falls/fractures and death in elderly nursing home patients suffering from depression.

Prescribed to treat a range of common conditions, including gastrointestinal, urinary tract and respiratory disorders, anticholinergics block the neurotransmitter chemical acetylcholine in varying degrees based on the specific drug’s anticholinergic activity.

The decrease in natural acetylcholine production during the aging process and the related progressive decline in the elderly are among the primary concerns associated with use of these drugs in older patients. Consequently, the use of one or more anticholinergics could exacerbate this age-related decrease in neurotransmission activity and cognitive performance.

Geriatric medicine practitioners are advised to avoid several anticholinergic agents as identified in the Beers Criteria, a guideline which categorizes medications that should be avoided in the elderly. In its 2012 Beers revision, the American Geriatrics Society noted that "many PIMs (potentially inappropriate medications) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults."

Separately, numerous studies have linked depression with cognitive impairment in older adults, but the degree of impact that anticholinergics have on patients with depression is not known.

Under a nearly $1 million grant from the Agency for Healthcare Research and Quality, Aparasu’s four-year project will examine clinically rich Minimum Data Set (MDS) linked Medicare claims data from the federal Centers for Medicare and Medicaid Services. Expected to incorporate medical data from more than 2 million patients, the project will be one of the largest studies of its kind.

"Ultimately, the goal is to improve the quality of life of geriatric patients,” Aparasu said. "By determining the health risks and impacts associated with anticholinergic drugs in this vulnerable population, our study will provide further evidence to help geriatric practitioners in their risk-benefit decision-making process."

The study will focus on drugs with “clinically significant” anticholinergic activity, as classified in the Anticholinergic Drug Scale (ADS) system developed by project co-investigator and specialist in geriatric pharmacy Ryan Carnahan, Pharm.D., M.S., BCPP, clinical assistant professor at the University of Iowa College of Public Health. UHCOP associate professors Hua Chen, Ph.D., M.D., and Michael Johnson, Ph.D., also are co-investigators on the project.

Carnahan said various factors, including insuffcient emphasis on geriatrics in medical school curricula and the lower pay for geriatricians, influence the general lack of awareness among clinicians of drug impacts in the elderly. Carnahahn's research team has developed pocket reference cards for clinicians with information on anticholinergics and other drugs that may cause delirium or cognitive impairment.

"When I talk to clinicians, more often than not a large proportion of them have never heard of the Beers list; it’s well known in the world of geriatrics, but generalists and other specialties don’t necessarily know about it," Carnahan said. "Some drugs have anticholinergic activity that is not recognized by clinicians, since it’s not their mechanism of action.

"In all cases, clinicians may not be aware of the risks, the magnitude of risk may not be well characterized, or they choose to accept the risks because they think the benefit of treatment could outweighs the risks."