Background and Importance The use of anticholinergic drugs and their cumulative effects are highly prevalent in older people and are associated with adverse effects and outcomes. However, pharmaceutical analysis to assess anticholinergic risk, remains a challenge due to constrained human resources, insufficient functionalities of prescription assistance software, non-interoperability of hospital information systems and the lack of awareness on the anticholinergic burden among elderly patients.

Aim and Objectives This study aimed to 1/evaluate and stratify anticholinergic scores based on patient profile, admission unit, and class of drugs, 2/propose guidelines for medication management and 3/secure drug related management by reducing anticholinergic patient’s exposure.

Material and Methods We conducted a retrospective study including all patients > 65 years admitted in our hospital from 1 April 2023 to 31 May 2023 using the CRIDECO Anticholinergic Load Scales (CALS) integrated in the Clinical Decision Support (CDSS) PharmaClass software 3.0 ®.¹

Results 1186 patients (n=1316 admissions) were enrolled with 130 patients re-hospitalised. Around 32% of patients with CALS ≥ 0 were admitted to the surgical department, 13% to a geriatric department and cardiology-pneumology each. In total, throughout their hospital stay, 64% (n=837) of admissions had no change in their CALS (largest group), 36% (n=469) of admissions had an increase and a minority had a decrease in score. For score ≥ 3, ≥ 4 and ≥ 5, increase was observed from admission to discharge of 26%, 16% and 12% respectively. Patients with increase of at least of 1 point of CALS were significantly older (pval<10^-4) and had increase length of hospital stay (pval<10^-15). The most common prescribed drugs were analgesics, anti-epileptic and diuretics.

Conclusion and Relevance Following the CRIDECO rule, 30% of patients > 65 years had a risk of anticholinergic burden at admission, and this risk does not decrease during hospitalisations. A threshold of five might be a potential cut-off choice for pharmaceutical interventions in future studies due to its significant increase for a small sample size. This further supports the feasibility and promising benefits of implementing new strategies for physicians with CDSS to improve medication management and to reduce the anticholinergic burden.

References and/or Acknowledgements 1. Ramos H, et al. CRIDECO Anticholinergic Load Scale: An Updated Anticholinergic Burden Scale.J Pers Med. 3 févr. 2022;12(2):207.

Conflict of Interest No conflict of interest.