National prescribing trends for high-risk anticholinergic medications in older adults

Taeho Greg Rhee

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Objectives: To estimate prescribing tends of and correlates independently associated with high-risk anticholinergic prescriptions in adults aged 65 and older in office-based outpatient visits. Design: Repeated cross-sectional analysis. Setting: National Ambulatory Medical Care Survey (NAMCS). Participants: A national sample of office-based physician visits by adults aged 65 and older from 2006 to 2015 (n=96,996 unweighted). Measurements: Prescriptions of high-risk anticholinergics, regardless of indication, were identified, and overall prescribing trends were estimated from 2006 to 2015. Stratified analyses of prescribing trends according to physician specialty and anticholinergic drug class were also performed. We used a multivariable logistic regression analysis to estimate the odds of high-risk anticholinergic prescription. Results: Between 2006 and 2015, a high-risk anticholinergic prescription was listed for 5,876 (6.2%) 96,996 visits of older adults, representative of 14.6 million total visits nationally. The most common drug classes were antidepressants, antimuscarinics, and antihistamines, which accounted for more than 70% of prescribed anticholinergics. Correlates independently associated with greater odds of receiving a high-risk anticholinergic prescription were female sex, the Southern geographic region, specific physician specialties (e.g., psychiatry, urology), receipt of 6 or more concomitantly prescribed medications, and related clinical diagnoses (e.g., urinary continence) (p<.01 for all). Conclusion: The prevalence of high-risk anticholinergic prescriptions was stable over time but varied according to physician specialty and drug class. Quality prescribing should be promoted because safer alternatives are available.

Original languageEnglish (US)
Pages (from-to)1382-1387
Number of pages6
JournalJournal of the American Geriatrics Society
Issue number7
Early online date2018
StatePublished - Jul 2018

Bibliographical note

Funding Information:
Conflict of Interest: In the past 36 months, Ross received research support through Yale University from Medtronic, Inc. and the Food and Drug Administration (FDA) to study post-market medical device surveillance, from the FDA to establish the Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation, from Johnson & Johnson to develop methods for clinical trial data sharing, from the Centers of Medicare and Medicaid Services to develop measures for public reporting of hospital and physician quality, from the Blue Cross-Blue Shield Association to advance premarket evidence generation for medical products, from the Agency for Healthcare Research and Quality, and from the Laura and John Arnold Foundation to support the Collaboration on Research Integrity and Transparency at Yale. Rhee and Ouellet received funding support from the National Institutes of Health (T32AG019134).

Publisher Copyright:
© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society


  • anticholinergics
  • older adults
  • outpatient care
  • prescribing


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