Medications and cognitive risk in Aboriginal primary care: a cross-sectional study

Marycarol Holdaway; Zoë Hyde; Jo-Anne Hughson; Roslyn Malay; Andrew Stafford; Kate Fulford; Kylie Radford; Leon Flicker; Kate Smith; Dimity Pond; Sarah Russell; David Atkinson; Irene Blackberry; Dina LoGiudice

doi:10.1111/imj.16323

Medications and cognitive risk in Aboriginal primary care: a cross-sectional study

Intern Med J. 2023 Dec 30. doi: 10.1111/imj.16323. Online ahead of print.

Authors

Marycarol Holdaway¹, Zoë Hyde², Jo-Anne Hughson¹, Roslyn Malay², Andrew Stafford³, Kate Fulford², Kylie Radford⁴, Leon Flicker², Kate Smith⁵, Dimity Pond⁶, Sarah Russell⁷, David Atkinson⁸, Irene Blackberry⁹, Dina LoGiudice^{1

10}

Affiliations

¹ Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
² Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia.
³ Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
⁴ Neuroscience Research Australia, Sydney, New South Wales, Australia.
⁵ Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth, Western Australia, Australia.
⁶ Department of General Practice, University of Newcastle, Newcastle, New South Wales, Australia.
⁷ College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
⁸ Rural Clinical School, University of Western Australia, Broome, Western Australia, Australia.
⁹ La Trobe University, John Richards Centre for Rural Ageing Research, Wodonga, Victoria, Australia.
¹⁰ Department Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.

PMID: 38158855
DOI: 10.1111/imj.16323

Abstract

Background: Aboriginal and Torres Strait Islander people are ageing with high rates of comorbidity, yet little is known about suboptimal prescribing in this population.

Aim: The prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care through Aboriginal Community Controlled Health Services (ACCHSs).

Methods: Medical records of 420 systematically selected patients aged ≥50 years attending urban, rural and remote health services were audited. Polypharmacy (≥ 5 prescribed medications), potentially inappropriate medications (PIMs) as per Beers Criteria and anticholinergic burden (ACB) were estimated and associated risk factors were explored with logistic regression.

Results: The prevalence of polypharmacy, PIMs and ACB score ≥3 was 43%, 18% and 12% respectively. In multivariable logistic regression analyses, polypharmacy was less likely in rural (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.24-0.77) compared to urban patients, and more likely in those with heart disease (OR = 2.62, 95% CI = 1.62-4.25), atrial fibrillation (OR = 4.25, 95% CI = 1.08-16.81), hypertension (OR = 2.14, 95% CI = 1.34-3.44), diabetes (OR = 2.72, 95% CI = 1.69-4.39) or depression (OR = 1.91, 95% CI = 1.19-3.06). PIMs were more frequent in females (OR = 1.88, 95% CI = 1.03-3.42) and less frequent in rural (OR = 0.41, 95% CI = 0.19-0.85) and remote (OR = 0.58, 95% CI = 0.29-1.18) patients. Factors associated with PIMs were kidney disease (OR = 2.60, 95% CI = 1.37-4.92), urinary incontinence (OR = 3.00, 95% CI = 1.02-8.83), depression (OR = 2.67, 95% CI = 1.50-4.77), heavy alcohol use (OR = 2.83, 95% CI = 1.39-5.75) and subjective cognitive concerns (OR = 2.69, 95% CI = 1.31-5.52). High ACB was less common in rural (OR = 0.10, 95% CI = 0.03-0.34) and remote (OR = 0.51, 95% CI = 0.25-1.04) patients and more common in those with kidney disease (OR = 3.07, 95% CI = 1.50-6.30) or depression (OR = 3.32, 95% CI = 1.70-6.47).

Conclusion: Associations between potentially suboptimal prescribing and depression or cognitive concerns highlight the importance of considering medication review and deprescribing for these patients.

Keywords: anticholinergic burden; cognitive risk; polypharmacy; suboptimal prescribing.

Abstract

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