Drug side effect linked with increased health risks for over 65s.(Report)

NewsRx Health July 17, 2011 A side effect of many commonly used drugs appears to increase the risks of both cognitive impairment and death in older people, according to new research led by the University of East Anglia (UEA).

As part of the Medical Research Council’s Cognitive Function and Ageing Studies (CFAS) project, the study is the first systematic investigation into the long term health impacts of ‘anticholinergic activity’ – a known potential side effect of many prescription and over the counter drugs which affects the brain by blocking a key neurotransmitter called acetylcholine. The findings are published by the Journal of the American Geriatrics Society.

Medicines with some degree of anticholinergic effect are wide-ranging and many are frequently taken by older people. The groups with the greatest impact include: anti-depressants such as Amitriptyline, Imipramine and Clomipramine; tranquilisers such as Chlorpromazine and Trifluoperazine; bladder medication such as Oxybutynin; and antihistamines such as Chlorphenamine. Other drugs with an anticholinergic effect include: Atenolol, Furosemide and Nifedipine for heart problems; painkillers such as Codeine and Dextropropoxyphene; the asthma treatment Beclometasone; the epilepsy treatment Carbamazepine; and Timolol eyedrops which are used for glaucoma. go to web site nexium side effects

The large cohort study was launched as part of the drive to find ways of reducing risk factors for dementia which affects 820,000 people in the UK. The UEA researchers worked in collaboration with colleagues at University of Cambridge, Indiana University and National Health Service clinicians. The project was funded by the Medical Research Council (MRC) and the US National Institute on Aging.

More than 13,000 men and women aged 65 and over from across the UK were included in the two-year study. Around half were found to use a medication with potential anticholinergic properties.

In the study, each drug taken by the participants was given a ranking based on the strength of its anticholinergic activity, or AntiCholinergic Burden (ACB) – 0 for no effect, 1 for mild effect, 2 for moderate effect and 3 for severe effect.

The key findings were:

o Twenty per cent of participants taking drugs with a total ACB of four or more had died by the end of the two-year study, compared with only seven per cent of those taking no anticholinergic drugs – the first time a link between anticholinergics and mortality has been shown.

o For every additional ACB point scored, the odds of dying increased by 26 per cent.

o Participants taking drugs with a combined ACB of five or more scored more than four per cent lower in a cognitive function test than those taking no anticholinergic medications – confirming evidence from previous smaller studies of a link between anticholinergics and cognitive impairment.

o The increased risks from anticholinergic drugs were shown to be cumulative, based on the number of anticholinergic drugs taken and the strength of each drug’s anticholinergic effect.

o Those who were older, of lower social class, and with a greater number of health conditions tended to take the most anticholinergic drugs.

Lead author Dr Chris Fox, clinical senior lecturer at Norwich Medical School, University of East Anglia, said: “This is the first large scale study into the long-term impact of medicines which block acetylcholine – a common brain neurotransmitter – on humans, and our results show a potentially serious effect on mortality. Clinicians should conduct regular reviews of the medication taken by their older patients, both prescribed and over the counter, and wherever possible avoid prescribing multiple drugs with anticholinergic effects. in our site nexium side effects

“Further research must now be undertaken to understand possible reasons for this link and, in particular, whether and how the anticholinergic drugs might cause the increased mortality. In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their family doctor or their pharmacist.” Co-author Prof Carol Brayne, principal investigator of the MRC CFAS project at the University of Cambridge, said: “It is important to scrutinise medications given to older people very carefully to try to minimise harm as well as gain the desired benefit. The admirable wish to give the best possible treatment with good evidence for individual conditions has to be balanced against the fact that in many older people with multiple conditions this will lead to accumulated risk such as that shown by this scale.” Ian Maidment, a mental health pharmacist working within the NHS, added: “One of the issues is that as we age, we tend to be prescribed more medicines which have an anticholinergic effect, increasing the overall burden.” Dr Susanne Sorensen, head of research at the Alzheimer’s Society, said: “It is very important that we have a clear picture of the side effects of drugs commonly taken by older people with cognitive impairment and other conditions. This robust study provides valuable findings, and must be taken seriously. However it is vital that people do not panic or stop taking their medication without consulting their GP.

“We would urge people to have regular appointments with their doctor to review all drug treatments they are taking. This will help ensure they are on the best medications for their conditions, and that any side effects have been taken into consideration.” Prof Chris Kennard, chairman of the MRC’s Neuroscience and Mental Health Board, which funded the research, said: “The Medical Research Council invests in cohort studies like CFAS because they provide vital clinical information through observation. Such projects require long-term commitment to fulfil their potential but having supported cohort studies for well over half a century, MRC funding and collaborations have made the UK an international leader in this field.”

Casino’s winning streak lifts small thrifts; success of Connecticut tribe’s venture fuels a revival.(Norwich Savings Society, Dime Savings Bank of Norwich and Chelsea-Groton Savings Bank profit from Foxwoods Casino)(includes related article on relations between Indian tribes and community banks) web site dime savings bank

American Banker May 13, 1996 | Epstein, Jonathan D.

Profiting from gambling is one of the last things a community banker might encourage other people to do.

But that wasn’t the case for the chief executives at three small southeastern Connecticut thrifts.

Five years ago, the three men – Dan Dennis, Jim Cronin, and Duncan Stoddard – were struggling to see the light at the end of the tunnel. With the state’s recession in full swing and the defense industry retrenching, their community was battling skyrocketing unemployment and slumping property values.

Those problems reverberated at their local thrifts – Norwich Savings Society, Dime Savings Bank of Norwich, and Chelsea-Groton Savings Bank -which saw nonperforming assets soar and loan losses mount.

All that changed, however, after the Mashantucket Pequot Indians opened the Foxwoods Casino in 1992, eventually supplying 11,000 new jobs and significant investment for the struggling rural community.

The injection resuscitated the area, helping it rebound from the recession far faster than the rest of the state. The casino also helped the fortunes of the three thrifts.

“Everyone in eastern Connecticut is affected by it, every county, every bank, every government,” said Mr. Dennis, chief executive of $711 million-asset Norwich Savings.

The casino has emerged as an unlikely savior for banks that have relied for years on more traditional sources of income.

While Mr. Dennis and his banking colleagues assert that they would have recovered eventually, they agree that it wouldn’t have happened as rapidly were it not for the casino’s success.

Foxwoods’ success is part of a surge in casino gambling on Indian reservations during the past few years. Since the beginning of the decade, at least 92 tribes in 19 states have signed more than 100 compacts for casino gambling with governments.

The agreements authorize games ranging from simple lotteries and off-track betting to blackjack, roulette, and baccarat, and even slot machines.

With almost 600 rooms in two hotels, and more than 250,000 square feet of casino space, Foxwoods has become a major tourist destination in New England. Tribal officials say it is the largest in the Western Hemisphere.

Its revenues have exceeded all expectations. Profits have topped $1 billion a year, most of it nontaxable because the reservation is technically sovereign land.

The regional recovery spawned by Foxwoods has also helped the thrifts’ earnings. Nonperforming assets are down significantly at all three institutions. In 1995, Norwich reported net income of $5.5 million, Chelsea-Groton had earnings of $4.2 million, and Dime had income of $1.8 million.

“We wouldn’t see the bad loans going away and being replaced by good loans if it weren’t for these things,” said $457 million-asset Chelsea-Groton’s Mr. Stoddard.

Although the thrifts are too small to handle the banking relationships for the casino, they have been asked to fund various other individual and tribal projects.

And the Mashantuckets have made sure to divide their deposit business among local banks. That supports the growth of the institutions, while ensuring competitive bidding for tribal projects.

“The success of it is well beyond not only the local people’s expectations, but even their wildest dreams and hopes,” said Mr. Cronin, chief executive at $159 million-asset Dime Savings.

“I know this tribe prefers to do locally what it can, and that involves community banks,” said tribal spokesman Bruce MacDonald. “We’ve made that a policy and a priority.” Since the little-known tribe opened four years ago, southeastern Connecticut has undergone a transformation that rescued it from the disaster that befell the rest of the state.

With its heavy reliance on defense industries, the area was rocked by defense cutbacks that led to, among other losses, about 14,000 job cuts at the General Dynamics Electric Boat submarine facility in Groton.

Almost simultaneously, the effects of the state’s recession and overbuilding in the condominium market led to a steep drop in property values in the area. About 40 banks failed statewide.

The poor conditions pounded the three thrifts. Norwich Savings recorded nonperforming assets of $50 million, or 50% of its capital, while Chelsea-Groton watched its bad assets rise to 70% of capital, or $34 million. see here dime savings bank

“I don’t think any banker realized in 1989 how devastating or deep an economic trough this would be,” Mr. Dennis said.

The growth of Foxwoods, however, sparked the region’s recovery within just two years of its opening.

“We’re not going to take credit for everything, but we’ve had a noticeable impact on the local economy,” Mr. McDonald said.

With the casino now in full operation and still growing, the Norwich area has seen a return to virtually full employment and the replenishment of once empty housing stock.

And economists say that the new jobs at the casino have also supported 20,000 new jobs in the county and 7,000 in the rest of the state, helping to reduce state welfare rolls.

Currently, Dime Savings Bank of Norwich is working with the Mashantuckets to offer a housing finance program to help tribe members who might not otherwise qualify for loans.

And Norwich Savings Society, which has maintained numerous loan relationships with the tribe since 1983, is seeking to open a branch at the casino for tribe members and casino workers.

The success of the casino also has its drawbacks, the bankers point out. Most notable are the losses incurred by gambling addicts, who may default on loans and bankrupt their businesses.

“There’s been a mixed bag there. It isn’t a panacea,” Mr. Cronin said. “I’m still thankful that it happened. I shudder to think of what might have happened if they were not there.” Epstein, Jonathan D.