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Ten‐year trajectory of potentially inappropriate medications in very old women: Importance of cognitive status


Koyama, Alain, Steinman, Michael, Ensrud, Kristine, Hillier, Teresa A., Yaffe, Kristine


Journal of the American Geriatrics Society, Volume: 61, No.: 2, Pages.: 258-263

Year of Publication



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. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)

Bibtex Citation

@article{Koyama_2013, doi = {10.1111/jgs.12093}, url = {}, year = 2013, month = {jan}, publisher = {Wiley-Blackwell}, volume = {61}, number = {2}, pages = {258--263}, author = {Alain Koyama and Michael Steinman and Kristine Ensrud and Teresa A. Hillier and Kristine Yaffe}, title = {Ten-Year Trajectory of Potentially Inappropriate Medications in Very Old Women: Importance of Cognitive Status}, journal = {Journal of the American Geriatrics Society} }


adverse, antispasmodics, cognitive ability, cognitive impairment, cognitive status, community services, dementia, drug therapy, events, human females, medication, mild cognitive impairment, x

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Cohort Study

Type of Outcomes




Type of Interventions

Pharmaceutical Interventions

Pharmaceutical Interventions

Anti-Alzheimer medications, e.g.: donezepil, galantamine, rivastigmine, memantime, Antipsychotics and antidepressants