Ten-Year Trajectory of Potentially Inappropriate Medications in Very Old Women: Importance of Cognitive Status.

Objectives To determine which older adults tend to receive potentially inappropriate medications ( PIMs), how this may differ according to cognitive status, and how the trajectories of PIM use change over time. Design Ten-year longitudinal cohort study. Setting Three clinical sites in the United States. Participants One thousand four hundred eighty-four community-dwelling women aged 75 and older. Measurements At follow-up, cognitive status was ascertained and classified as normal, mild cognitive impairment ( MCI), or dementia. Beers 2003 criteria and other literature were used to identify PIMs from detailed medication inventory performed at three time points. Anticholinergic load was measured using the Anticholinergic Cognitive Burden Scale ( ACB), which assigns medications a value from 0 to 3 depending on anticholinergic properties. Results At baseline, 23.9% of women were taking at least one PIM and the mean ± SD ACB score was 1.41 ± 1.69. The most frequently reported PIMs were anticholinergics (15.2%), benzodiazepines (8.6%), and antispasmodics (8.0%). Over 10 years, PIM use increased for women with dementia (24.9-33.1%; P = .02) but remained fairly constant for women with MCI (23.9-23.0%; P = .84) and normal cognitive status (22.2-19.8%; P = .17). Mean ACB score increased significantly ( P < .001) over time for all groups (dementia: 1.28-2.05; MCI: 0.98-1.66; normal: 0.99-1.48). Conclusion PIM use and anticholinergic load in a community-dwelling population of older women was high, especially in women who later developed dementia. Future guidelines should limit PIM use and seek safer alternatives. [ABSTRACT FROM AUTHOR]