Background and importance Anticholinergic burden has been associated with cognitive and functional impairment, risk of falls, hospitalisations and morbidity/mortality, especially in older patients.
Aim and objectives To study the anticholinergic burden in older patients in a hospital setting and to reduce the use of drugs with anticholinergic effects (DACE) in those patients with a high anticholinergic risk (HAR).
Material and methods A cross sectional study was conducted in patients aged ≥65 years of age, admitted to the internal medicine department. The study was scheduled once a week for 4 weeks between August and September 2019. Patients with palliative care and readmissions were excluded. Gender, age, length of hospital stay and the number of drugs prescribed were registered. The anatomical, therapeutic and chemical (ATC) classification was used to classify drugs. Anticholinergic burden was calculated using the drug burden index (DBI) calculator (available at: http://anticholinergicscales.es/patients). Ophthalmic drugs and medication ‘as needed’ were not assessed. The medication plan of patients with HAR was reviewed together with their physicians in order to reduce the anticholinergic burden through reducing the dose, stopping treatment or changing the DACE.
Results Eighty-two patients (70% women, 85±8 years old) were included. Median length of hospital stay and number of drugs prescribed per patient were 7 days and 10±3.5 drugs, respectively. Fifty-nine patients (72%) had at least one DACE prescribed (an average of two DACE per patient). Most common DACE grouped by ATC were: anxiolytics (N05B, n=30), antidepressants (N06A, n=28), antipsychotics (N05A, n=22), opioids (N02A, n=16) and antiepileptic (N03A, n=14). Thirty-two (39%) patients had a moderate anticholinergic risk (median DBI 0.6) and 27 (33%) patients had a HAR (median DBI 1.5). Four out of 27 (15%) interventions were accepted and consisted of two dose reductions and two DACE deprescriptions. The interventions were not accepted mainly because the drugs were part of the patient’s chronic psychiatric or neurological treatment, the presence of refractory pain or insomnia disorders.
Conclusion and relevance Our pharmacological intervention was poorly accepted by physicians. During the hospitalisation process it is difficult to re-evaluate the need for adjusting chronic medication, especially related to psychiatric or neurological pathologies. For future studies we believe that this type of study would have more impact at the primary care level.
References and/or acknowledgements No conflict of interest.
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