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Use of tricyclic antidepressants and other anticholinergic medicines by older Aboriginal Australians: association with negative health outcomes

Published online by Cambridge University Press:  28 September 2020

Karen Mate Open the ORCID record for Karen Mate [Opens in a new window] ,
Karen Kerr ,
Alison Priestley ,
Natasha Weaver ,
Gerald A. Broe ,
Gail Daylight ,
Brian Draper ,
Robert Cumming ,
Hemi Robinson-Kingi  and
Kim Delbaere
...Show all authors
Karen Mate*
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
Karen Kerr
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
Alison Priestley
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
Natasha Weaver
Affiliation:
School of Medicine & Public Health, University of Newcastle, Callaghan, NSW, Australia
Gerald A. Broe
Affiliation:
Neuroscience Research Australia, Randwick, NSW, Australia Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
Gail Daylight
Affiliation:
Neuroscience Research Australia, Randwick, NSW, Australia
Brian Draper
Affiliation:
Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia Department of Old Age Psychiatry, Prince of Wales Hospital, RandwickNSW, Australia
Robert Cumming
Affiliation:
School of Public Health, University of Sydney, Darlington, NSW, Australia
Hemi Robinson-Kingi
Affiliation:
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
Kim Delbaere
Affiliation:
Neuroscience Research Australia, Randwick, NSW, Australia Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
Kylie Radford
Affiliation:
Neuroscience Research Australia, Randwick, NSW, Australia Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
*
Correspondence should be addressed to: Dr Karen Mate, School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia. Phone: +61 2 49215983. Email: [email protected].
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Abstract

Background:

Aboriginal and Torres Strait Islander Australians have a relatively high prevalence of multimorbidity requiring treatment with medications. This study examines medication use and anticholinergic burden (ACB) among a cohort of older Aboriginal and Torres Strait Island people.

Method:

This cross-sectional study involving five Aboriginal communities (two in metropolitan Sydney and three on the mid-north coast of New South Wales) used a structured interview process to assess cognition, depression, and activities of daily living for a cohort of older adults (aged 60 years and over). Participants also reported on their health status, medical history, and prescription medications during the interview. ACB was calculated, and its association with adverse health outcomes including cognitive impairment, falls, hospitalization, and depressive symptoms were examined.

Results:

Most participants (95%) were taking at least one regular medication with polypharmacy (≥5 medications) observed in 43% of participants; 12.2% had a significant ACB (≥3) with antidepressants being a major contributor. Anticholinergic medication use was associated with cognitive impairment, recent hospitalization (past 12 months), and depressive symptoms. After controlling for age, sex, and comorbidity, only the presence of depressive symptoms remained significantly associated with the use of anticholinergic medication (odds ratio 2.86; 95% confidence interval 1.48–5.51).

Conclusions:

Clinically significant ACB was common in older Aboriginal Australians and was largely attributable to inappropriate use of tricyclic antidepressants. Greater awareness of medication-related risk factors among both health care professionals and Aboriginal communities can play an important role in improving health and quality of life outcomes.

Keywords

quality of health carecholinergic antagonistsdementiapopulation characteristicsaged
Type
Original Research Article
Information
International Psychogeriatrics , Volume 34 , Special Issue 1: Issue Theme: Varied Angles of Geriatric Depression , January 2022 , pp. 71 - 78
Copyright
© International Psychogeriatric Association 2020

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Footnotes

*

Joint senior authors.

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