Abstract
Background
Use of anticholinergic medication is increasing, especially among the older population due to polypharmacy and co-morbidities. High anticholinergic burden is associated with adverse effects such as reduced mobility and future dementia risk. Acute hospital stay may be an appropriate time to target this commonly overlooked problem.
Aims
To explore the effects of deprescribing medications with anticholinergic burden on health outcomes of hospitalised older people.
Method
Medline, Web of Science, Cochrane Library and Embase were searched for relevant papers from database inception to September 2024. Studies that involved a deprescribing or medication review intervention to reduce anticholinergic burden within a hospital setting in older people (≥65 years old) were included. Synthesis Without Meta-analysis guidelines were used for narrative synthesis and Joanna Briggs Institute Checklists were used for quality assessment.
Results
2042 papers were identified, and eight papers were included in this review. There was heterogeneity of design and outcomes across the studies with generally short follow-up. Study designs included: cohort (n=4), pre-post quasi-experimental (n=3) and audit (n=1). Outcomes reported included: medication-related outcomes (n=8), acceptability (n=4) and clinical outcomes (n=1). No studies reported on safety or costs. Six studies reported a reduction in anticholinergic burden score following the intervention, two studies demonstrated a significant reduction in the proportion of patients taking anticholinergic medication following intervention. The quality of the studies varied and ranged from poor to moderate.
Conclusion
This review found that deprescribing interventions within a hospital setting may be acceptable and successful in reducing anticholinergic burden in older adults. However, effectiveness of intervention on important clinical outcomes could not be determined due to short follow-ups and limited data on clinical outcomes, costs, and safety. In future, there is a need for randomised controlled trials to focus on clinical outcomes and involve longer durations of follow-up.
Comments
Really interesting work, in…
Really interesting work, in an often-neglected topic. You mention that study quality ranged from poor to moderate, what were the most common methodological weaknesses you identified across the included studies?
Thank you for your question...
One of the common methodological weaknesses across studies was the failure to identify confounding factors and three of the studies failed to create strategies to deal with these confounding factors. Also, as stated in the poster the lack of follow-up was the key weakness seen in the majority of studies. However, all studies measured outcomes in a reliable way and used appropriate statistical analysis.
Great topic!
Thank you for highlighting this important and interesting topic! In my practice I make interventions to reduce ACB scores, it would be great if we had more high quality evidence to support the long term benefits of these interventions!