Background and Importance Anticholinergic drugs are considered as potentially inappropriate in older adults. Different scales are available to quantify anticholinergic burden. A score ≥ 3 is considered as increasing the risk of side effects. Clinical pharmacists can play an important role in reducing anticholinergic drug prescription, but resources are limited. A clinical decision support system (CDSS) based on anticholinergic burden scales can help pharmacists to identify patients at higher risk of anticholinergic side effects.

Aim and Objectives The objective of this prospective study was to evaluate the prescription of anticholinergic drugs in a geriatric rehabilitation unit (RU) and the anticholinergic burden for each patient regarding the prescription at home, at discharge of acute care, on admission in RU and at discharge to home.

Material and Methods All patients, aged > 65 years, with at least one anticholinergic drug on admission in RU or during the stay were eligible. The CDSS Pharmaclass® was used to detect patients with anticholinergic drugs, based on the CRIDECO anticholinergic burden scale. When the score was ≥ 3, the pharmacist evaluated the situation and informed the physician. If needed, he suggested pharmaceutical interventions.

Results 132 patients were included between April and May 2023. Average anticholinergic score was 1.83 (+/- 1.6 SD) for the usual home treatment, 2.81 (+/- 1.78 SD), the last day in the acute unit, 2.45 (+/- 1.54 SD) on admission in the RU and 1.81 (+/- 1.54 SD) at discharge. 40% of the patients had an anticholinergic score ≥ 3 on admission and 24% at discharge. Anticholinergic drugs were prescribed 349 times with analgesics being the most prescribed (24%), followed by antidepressants (16%). Pharmacist informed the prescriber about a score ≥ 3 for 58 patients and realised 45 interventions with an acceptance rate of 82%.

Conclusion and Relevance Hospitalisation in acute care led to an increase of anticholinergic drug prescription. A stay in a geriatric rehabilitation unit before discharge helped reducing this burden. Sensitivity of geriatrician regarding inappropriate prescriptions as well as focused pharmaceutical interventions, supported by a CDSS, result in this score reduction. This study reveals the need to deploy the anticholinergic alert of CDSS to other wards in acute care.

Conflict of Interest No conflict of interest.