Survey of the prescribing pattern and use of anticholinergic medications in the institutionalized elderly

Of the people aged 65 and over in Canada, 9% are institutionalized, and a significant percentage of these people have memory impairment and dementia. Anticholinergic agents may cause the anticholinergic intoxication syndrome which results in memory impairment and confusion. Confusional states have been reported almost twice as frequently in demented patients taking anticholinergic medication. We surveyed 435 elderly patients in a chronic care institution and found that 45% of those surveyed were receiving one or more drugs with anticholinergic side effects. Fifty-eight percent were receiving five or more scheduled medications. We caution against such frequent use of these agents in this population, and recommend that where there is a choice between two agents, that the one with lesser anticholinergic effects be used.