Anticholinergic Burden Research Articles

Cognitive impact of anticholinergic and sedative burden in people with HIV.

This study aims to estimate the extent to which anticholinergic and sedative burden is associated with cognitive ability and self-reported cognitive difficulties (SCD) in middle-aged and older adults living with HIV. This cross-sectional analysis examined data from the inaugural visit of participants enrolled in the Positive Brain Health Now (BHN) study. Cognitive ability was measured using the Brief Cognitive Ability Measure (B-CAM; higher is better) and SCD using the Perceived Deficits Questionnaire (PDQ; higher is worse). Medication burden was quantified using several scoring systems, including the Anticholinergic Cognitive Burden (ACB), Anticholinergic and Sedative Burden Catalog (ACSBC), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and the Sedative Load Model (SLM). Multivariable Ordinary Least Squares and quantile regression were utilized to estimate average effects and distribution-specific impacts, respectively. Of 824 participants (mean age 53 years, 84.7% men), 41.4% used anticholinergics (ACSBC) and 39% used sedatives (SLM). High anticholinergic burden was linked to worse cognitive ability [ β = -3.81; 95% confidence interval (CI): -7.16, -0.46] and SCD ( β = 3.89; 95% CI: 1.08, 6.71). Using three or more anticholinergics worsened cognitive ability ( β = -4.45; 95% CI: -8.54, -0.35), and using three or more sedatives increased SCD ( β = 4.35; 95% CI: 0.92-7.78). Stronger negative associations were observed in participants with lower cognitive ability and more difficulties. These results suggest that anticholinergic and sedative burden may contribute to cognitive impairment in people with HIV. Personalized medication management and regular cognitive assessments could mitigate these adverse effects.

The effect of anticholinergic burden on diabetes regulation in non-demented elderly

The effect of anticholinergic burden on diabetes regulation in non-demented elderly

Impact of Anticholinergic Burden on Cognitive Functions in Individuals with Bipolar Disorder, Schizoaffective Disorder, and Schizophrenia

Impact of Anticholinergic Burden on Cognitive Functions in Individuals with Bipolar Disorder, Schizoaffective Disorder, and Schizophrenia

Selecting a Brief Cognitive Screening Test Based on Patient Profile: It Is Never Too Early to Start

Introduction: Cognitive impairment, marked by a decline in memory and attention, is frequently underdiagnosed, complicating effective management. Cardiovascular risk factors (CVR) and anticholinergic burden (ACB) are significant contributors to dementia risk, with ACB often stemming from medications prescribed for neuropsychiatric disorders. This study evaluates cognitive profiles through three brief cognitive tests, analyzing the impact of CVR and ACB presence. Methods: This cross-sectional study was performed between 2019 and 2023 in community pharmacies and an outpatient clinic in Valencia, Spain. Eligible participants were patients with subjective memory complaints 50 years or older with clinical records of cardiovascular factors. Patients with conflicting information regarding diabetes diagnosis or not taking concomitant medications were excluded. Three brief cognitive tests (Memory Impairment Screening (MIS), Semantic Verbal Fluency Test, and SPMSQ) were assessed. CVR was calculated using the European SCORE2 table, and ACB was assessed using the CALS scale. Results: Among 172 patients with memory complaints and CVR factors, 60% failed at least one cognitive test. These patients were on significantly more medications and had higher blood pressure and HbA1c levels. An increase in CVR and ACB was associated with more failed tests. Additionally, elevated SCORE2 scores were associated with a greater failure rate on the MIS test, while patients with elevated ACB more frequently failed the SPMSQ test. Conclusions: Selecting an adequate brief cognitive test according to patients’ characteristics offers an opportunity to screen patients who are probably cognitively impaired. Whereas the MIS test may be helpful for patients with cardiovascular risk, SPMSQ stands out among patients with significant ACB.

Understanding the medication regimens associated with anticholinergic burden in older people's mental health services in the UK.

Medications with anticholinergic properties are associated with a range of adverse effects that tend to be worse in older people. To investigate medication regimens with high anticholinergic burden, prescribed for older adults under the care of mental health services. Clinical audit of prescribing practice, using a standardised data collection tool. Fifty-seven trusts/healthcare organisations submitted data on medicines prescribed for 7915 patients: two-thirds (66%) were prescribed medication with anticholinergic properties, while just under a quarter (23%) had a medication regimen with high anticholinergic burden (total score ≥3 on the anticholinergic effect on cognition (AEC) scale). Some 16% of patients with a diagnosis of dementia or mild cognitive impairment were prescribed medication regimens with a high anticholinergic burden, compared with 35% of those without such diagnoses. A high anticholinergic burden was mostly because of combinations of commonly prescribed psychotropic medications, principally antidepressant and antipsychotic medications with individual AEC scores of 1 or 2. Adults under the care of older people's mental health services are commonly prescribed multiple medications for psychiatric and physical disorders; these medication regimens can have a high anticholinergic burden, often an inadvertent consequence of the co-prescription of medications with modest anticholinergic activity. Prescribers for older adults should assess the anticholinergic burden of medication regimens, assiduously check for adverse anticholinergic effects and consider alternative medications with less anticholinergic effect where indicated. The use of a scale, such as the AEC, which identifies the level of central anticholinergic activity of relevant medications, can be a helpful clinical guide.

215 - Anticholinergic burden in treatment naïve OAB patients: how much is too much?

215 - Anticholinergic burden in treatment naïve OAB patients: how much is too much?

Association between anticholinergic burden and nutritional status: MNA-SF and GLIM criteria

Association between anticholinergic burden and nutritional status: MNA-SF and GLIM criteria

216 - Persistence of Vibegron treatment in elderly patients aged 80 years or over with overactive bladder: The impact of anticholinergic burden and polypharmacy

216 - Persistence of Vibegron treatment in elderly patients aged 80 years or over with overactive bladder: The impact of anticholinergic burden and polypharmacy

Appropriate Prescribing of Antipsychotic Medication Amongst Long-Term Care Facility Residents Admitted to Hospital

Abstract Background In Ireland, it is estimated that up to 45% of long-term care facility residents (LTCR) living with dementia are prescribed antipsychotic medication1. Although antipsychotics have moderate benefit in treating neuropsychiatric symptoms, their use must be carefully weighed against an adverse side effect profile. This study aims to describe the prevalence of antipsychotic usage in LTCR admitted to hospital, and to determine the appropriateness of the prescription as outlined by the National Clinical Guideline 21. This study describes the efficacy of a new Nursing Home Liaison (NHL) service (consisting of two advanced practice nurses) in reducing inappropriate prescribing. Methods Hospital admissions were screened daily to identify LTCR. Medical chart and drug kardex review was performed to collect demographic data, dementia diagnosis, and antipsychotic prescription. Anticholinergic burden was calculated using the ACB score. If the indication for antipsychotic was not clear post review, the NHL service obtained collateral history to determine reason for prescription, making recommendations to wean and stop the medication where appropriate. Results Data was prospectively collected on 50 consecutive LTCR, 28 (57%) were male and the average age was 81years. 26 (51%) of patients had a diagnosis of dementia. A total of 11 (22%) patients were prescribed antipsychotics; of these, seven (64%) had dementia and the rest had psychiatric diagnoses. The mean anticholinergic burden was 2.4 (range 0-7). Five (45%) of the antipsychotic prescriptions were not justified as per Guideline 21 or were no longer needed. These were amended as per the advice of the NHL service. Conclusion This study highlights rates of inappropriate prescribing of antipsychotics among LTCR, resulting in high anticholinergic burden and the associated risks. Medication review and advice from a specialist NHL service, was effective in reducing inappropriate prescriptions. Further education and dissemination of Guideline 21 is prudent to ensure proper prescribing and de-prescribing practices.

Employing Shared Decision Making (SDM) to reduce the Anti-Cholinergic Burden (ACB)

Abstract Background Anticholinergic medicines can cause a range of adverse drug reactions (ADRs) including urinary retention, dry mouth, constipation, tachycardia, blurred vision, sedation, dizziness, confusion and delirium. 10% of hospital admissions in those >65 years of age are Adverse Drg Reaction (ADR) related, and approximately 70% of these can be avoided. Shared decision making (SDM) is a joint process in which a healthcare professional works with a person to reach a decision about their care. Medicines should be deprescribed, if a shared decision is reached that the risks outweigh the benefits for the individual. Methods Results Thirty-eight patients, with a mean age of 76 years received a medication review. The mean number of regular medicines pre-review was 10.5 and post review was 9.3. The mean ACB score pre-review was 5.4 and post review was 3.5. An ACB reduction was achieved in 25 patients (66%) patients. The total ACB score reduction achieved was 73. 90% of the total reduction was achieved by stopping urinary antispasmodics, amitriptyline, quetiapine, promethazine and lansoprazole. Conclusion Targeting future SDM interventions to patients on those anticholinergic medicines found to be amenable to deprescribing might be an efficient way to reduce anticholinergic burden and harm.

Identification and Modification of Fall-Risk-Increasing-Drugs Following Fall-Related Hospitalization in Older Adults

Abstract Background Falls are a common cause of hospitalization in older adults and carry a significant risk of morbidity and mortality. Polypharmacy and certain medications are strongly associated with increased falls risk. Guidelines recommend that falls requiring hospitalization should trigger a multi-factorial risk assessment, including medication review. This study aims to describe the prevalence of fall-risk-increasing-drugs (FRIDs) in older adults admitted with a fall, and to determine whether or not these medications are appropriately identified, reviewed and modified as per the hospital’s recently developed ‘Guideline on Medication and the Risk of Falls’. Methods Hospital admissions were screened daily to identify fallers. Medical chart and drug kardex review was performed to collect demographic data and FRIDs prescription. Anticholinergic burden was calculated using the ACB score. Documentation of medicine reconciliation, indication for FRIDs, and modification of FRIDs by the admitting team was recorded. Results Data was prospectively collected on 25 consecutive patients, 18 (72%) were female and the average age was 82. Overall, 23 (92%) of were prescribed FRIDs and 21 (84%) had polypharmacy. Average ACB score was 1.76 (range 0-6). The most commonly prescribed FRIDs were anti-hypertensives (72%), diuretics (48%) and anti-depressants (44%). FRIDs were identified as a potential cause of falls in six (24%) cases, and their indication was documented in four (16%) cases. FRIDS were reduced, stopped or changed to a safer alternative in eight (32%) of cases. Conclusion FRIDs are commonly prescribed for older adults, with an average of three FRIDS prescribed per patient in this study. The need for improvement in recognition and documentation of FRIDs as potential contributors to falls has also been highlighted. Further education and dissemination of the ‘Guideline on Medication and the Risk of Falls’ is prudent to ensure proper prescribing and de-prescribing practices.

The Prevalence of Potentially Inappropriate Medications (PIMs) Among Frail Older Participants of The Irish Longitudinal Study on Ageing (TILDA)

Abstract Background This study aimed to assess PIMsprevalence among frail older participants of The Irish Longitudinal Study on Ageing (TILDA), using a newly developed OPTI-3S criteria (criteria for OPTImising medicines by Stopping, Stepping down, or Switching to safer alternatives). Methods All TILDA participants with polypharmacy (i.e. ≥5 medicines) and frailty based on Clinical Frailty Scale (CFS) ≥4 were included. PIMswere assessed based on the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail v2) [1], Poudel et al. algorithm [1], the Norwegian General Practice--Nursing Home criteria (NORGEP-NH) [1], and OPTI-3S. The prevalence of PIMsidentified by each tool was assessed across all frailty levels (CFS ≥4). Poisson regression assessed associations between PIM prevalence and covariates (e.g. medications). Results Most of the study cohort (86.5%, n=504) had at least one PIM identified by any of the four tools. OPTI-3S identified at least one PIM in 62.6% of participants, followed by Poudel’s algorithm (53.9%) and NORGEP-NH (40.5%). OPTI-3S could identify at least one PIM in 97.8% of participants with CFS ≥7, followed by STOPPFrail (88.9%). Overall, 34.8% of prescribed medications were considered to be PIMsThe OPTI-3S list detected more PIMsthan any other tool for all frailty levels (e.g. OPTI-3S, 78.4% vs STOPPFrail, 40.2% in CFS ≥7). Deprescribing all OPTI-3S-defined PIMswould reduce polypharmacy by 20.6% compared to NORGEP-NH (13.3%) and Poudel’s algorithm (12.0%). The most prevalent PIMswere aspirin, benzodiazepines and z-drugs, and antihypertensive medications. The number of medications, anticholinergic burden, and being on specific medications (e.g. aspirin, NSAIDs, benzodiazepines, antidepressants) were significantly associated with increased PIMs. Conclusion OPTI-3S is a useful PIM screening tool in community-dwelling frail older adults, pending further testing in the hospital setting. Reference 1. Anlay, D.Z et al. Br J Clin Pharmacol. 2024;90(1):12-106.

Implementing a Pilot Geriatric Oncology Service at a National Cancer Centre in Dublin

Abstract Background The American Society of Clinical Oncology and International Society of Geriatric Oncology recommend comprehensive geriatric assessment (CGA) for older adults commencing systemic anti-cancer treatments (SACTs) (1, 2). Routine CGA is lacking in cancer centres nationally. Methods A pilot, interdisciplinary geriatric-oncology (GO) clinic comprising a geriatric medicine consultant and specialist registrar, medical oncology fellow, physiotherapist and occupational therapist was established Dec 2023. New oncology patient referrals were screened applying the G8 tool; a score of ≤14 triggering referral. Polypharmacy was defined as ≥5 regular medications. Frailty was assessed using Clinical Frailty Scale (CFS) and cognition using Montreal Cognitive Assessment (MoCA). Results To date, 30 patients have attended the clinic; mean age 77.2 (SD5) years (range 68-85); 73% female, 50% with a CFS score of ≥4. Sixty-percent (n=18) were due to commence chemotherapy, the remainder hormonal or targeted treatment. Polypharmacy was identified in 66.6% (n=20), with 13.3% (n=4) having an anti-cholinergic burden score of ≥3, MoCAs were completed in 60% (n=18), of whom 77.8% (n=14) had an abnormal result (<26/30 MoCA or <18/22 MoCA blind). Twenty-six percent (n=8) reported ≥1 fall in the preceding six-months. Deprescribing interventions were completed in 40% (n=12); 58.3% (n=7) had ≥2 medications stopped. Medications most commonly deprescribed included opioids (n=2), antihypertensives (n=2), statins (n=2). Ambulatory blood pressure monitors were arranged for 33.3% (n=10) and DEXAs for 40% (n=12) and appropriately actioned. Follow up was arranged in the Falls and Syncope Unit for 7%, day hospital 10%, geriatric outpatients 10%, group psycho-oncology sessions 20%, specialist cancer rehabilitation physiotherapy service 17%. Parkinsons disease and dementia were diagnosed in 1 and 1 patients, respectively. Each patient had a detailed assessment and plan forwarded to their treating oncologist. Conclusion The development of a dedicated GO service is in line with international standards. By undergoing CGA, geriatric syndromes amenable to intervention were identified in patients.

A historical perspective on anticholinergics in overactive bladder (OAB) treatment: “Foundations, current practices, and future prospects”

Antimuscarinics have long been the cornerstone of treatment for overactive bladder (OAB), with their use spanning decades. This paper reviews the pharmacological properties, historical use, clinical efficacy, and challenges associated with antimuscarinics, revealing that concerns regarding their side effects and lack of bladder selectivity have persisted throughout their history.While long-term efficacy and safety have been established in various populations, adherence remains low due to side effects such as dry mouth, constipation, and cognitive impairment. The risk of cognitive side effects has led to increased scrutiny in older adults, where polypharmacy and anticholinergic burden are significant concerns. Despite advances, including newer formulations like extended-release versions and transdermal applications that improve tolerability, the fundamental issues of adherence and side effects have not been fully resolved.Intravesical administration has been explored to reduce systemic side effects, though its use remains limited to specific patient populations. Future directions in OAB treatment focus on exploring new pharmacological targets, including ion channels, enzymatic pathways, and gene therapy, to develop more selective and effective therapies. Additionally, phenotyping patients with OAB and personalised medicine approaches may enhance treatment outcomes. Despite these persistent challenges, antimuscarinics remain a critical component in the management of OAB.

Frailty and Medication Appropriateness in Rural Adults: Proposing Interventions through Pharmacist-Physician Collaborative Efforts.

Background: Frailty and polymedication are closely interrelated. Addressing these concurrent conditions in primary care settings relies on the utilization of potentially inappropriate medication (PIM) lists and medication reviews (MRs), particularly in rural areas, where healthcare professionals serve as the sole point of access to the medical system. The aim of this study was to examine the relationship between medication appropriateness and variables related to frailty in a rural municipality in order to propose potential strategies for therapy optimization. Methods: This cross-sectional study included all adult community dwellers aged 50 and above officially registered in the municipality of Tiriez (Albacete, Spain) in 2023 (n = 241). The primary outcome variable was frailty (assessed using the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale). The independent variables were age, gender, medication regimen, history of falls, comorbidities, PIMs (evaluated using the screening tool of older persons' prescriptions (STOPP) 2023 criteria), fall-risk-increasing drugs (FRID), and anticholinergic burden (ACB). Results: The prevalence of frailty was approximately 20%. FRID and ACB scores were statistically associated (p-value < 0.001) with frailty, 1.1 ± 1.3 vs. 2.5 ± 1.7, and 1.0 ± 1.3 vs. 2.8 ± 2.5, respectively. Regardless of age, frailty was observed to be more prevalent among females (odds ratio (OR) [95% confidence interval (CI)]: 3.5 [1.5, 9.0]). On average, 2.1 ± 1.6 STOPP criteria were fulfilled, with the prolonged use of anxiolytics and anti-peptic-ulcer agents being the most frequent. Priority interventions (PIs) included opioid dose reduction, benzodiazepine withdrawal, and the assessment of antidepressant and antiplatelet treatment plans. Conclusions: The optimization of medication in primary care is of paramount importance for frail patients. Interventional measures should focus on ensuring the correct dosage and combination of drugs for each therapeutic regimen.

Evaluation of drug prescriptions on hospital admission in older trauma patients using the Fit fOR The Aged (FORTA) rules.

Orthogeriatric comanagement of older patients with hip fractures has been proven to provide significant benefits concerning functional status, readmissions, nursing home placement, in-hospital complications and mortality. Medication management in older individuals is acornerstone in orthogeriatric comanagement. The aim of the study was to analyze the extent of overprescription and undertreatment in older trauma patients. Personal and medical data of consecutively admitted older trauma patients were analyzed. Evaluation of medication was conducted according to the Fit fOR The Aged (FORTA) criteria. Data were retrieved from an ongoing observational study on the incidence of delirium in surgical patients. Atotal of 492 patients were enrolled. There were 374 cases of overprescription and 575 cases of undertreatment. Only 78(16%) patients had neither overprescription nor undertreatment on admission. Overprescription and undertreatment were most prevalent in cardiovascular disease. Undertreatment was most prevalent concerning osteoporosis. The number of prescribed drugs correlated with the Charlson Comorbidity Index (r = 0.478, p < 0.001), age (r = 0.122; p < 0.01), anticholinergic burden (r = 0.528, p < 0.001), FORTA score (r = 0.352, p < 0.001), and overtreatment (r = 0.492, p < 0.001), but not with undertreatment. Undertreatment also correlated with age (r = 0.172, p < 0.001) and overtreatment (r = 0.364, p < 0.01). The FORTA score correlated significantly with age (r = 0.159, p < 0.001), anticholinergic burden (ACB) score (r = 0.496, p < 0.001), Katz index (r = -0.119, p < 0.01), IADL score (r = -0.243, p < 0.001), and clinical frailty scale (CFS, r = 0.23, p < 0.001). The high numbers of overprescription and undertreatment in older trauma patients underlines the need for orthogeriatric comanagement. Besides the evaluation of multimorbidity and geriatric problems, drug management is acore topic. Future studies should investigate the impact of medication management on outcome parameters such as quality of life, functional status, and mortality. Abenefit can be expected.

Delirium event and associated treatment modifications among older adults with Alzheimer's disease: An interrupted time-series analysis of Medicare data.

Both Alzheimer's disease (AD) and deliriogenic medications increase the risk of delirium in older adults. This study examined the association between delirium and the subsequent monthly use of anticholinergic, sedative, and opioid medications in the 1 year after delirium in older adults with AD. This comparative interrupted time series analysis involved adults (aged 65 years and older) with a diagnosis of AD initiating on cholinesterase inhibitors (ChEIs) based on 2013-2017 Medicare data. Separate patient-level segmented regression models were used for each outcome to evaluate changes in the cumulative anticholinergic burden (CAB), sedative load, and opioid load after the delirium/index event using a 12-month baseline and follow-up period among patients who had a delirium event and those without delirium (control group). Propensity score-based stabilized weights were utilized to balance baseline factors in the delirium and control groups. The study included 80,019 older adults with AD with incident ChEI use; 17.11% had delirium. There was an immediate decline in monthly CAB after the delirium event (mean estimate -0.86, p-value: 0.01) compared to the control group. A similar decline was observed when examining the sedative load (-0.06, p-value: 0.002) after the delirium event. However, there was no decline in opioid load (-0.50, p-value: 0.18). In the long term, CAB (0.13; p-value: <0.0001), sedative load (0.01; p-value: <0.001), and opioid load (0.07; p-value: 0.006) increased over the 1-year post-delirium period in the delirium group compared to those without delirium. This study found the burden of deliriogenic medications over the 1-year follow-up showed increasing trends in older adults with AD, even though there was some level shift in CAB and sedative load after the delirium event.

The usage of anticholinergic medications in a low- and middle-income country: a longitudinal comparison of 2013-15 and 2020-22 datasets.

While the effects of anticholinergic drug use have been increasingly highlighted, trends in anticholinergic use remain poorly understood. To determine the changes in frequency and pattern of anticholinergic drug use within a low- and middle-income country. Comparisons were made between population-based datasets collected from Malaysian residents aged 55years and older in 2013-15 and 2020-22. Anticholinergic exposure was determined using the anticholinergic cognitive burden (ACB) tool. Drugs with ACB were categorised according to the Anatomical Therapeutic Chemical (ATC) classification. A total number of 5707 medications were recorded from the 1616 participants included in the 2013-15 dataset. A total number of6175 medications were recorded from 2733 participants in 2020-22. Two hundred and ninety-three (18.1%) and 280 (10.2%) participants consumed medication with ACB in 2013-15 and 2020-22 respectively. The use of nervous system drugs with ACB had increased (27 (0.47%) versus 39 (0.63%). The use of ACB drugs in the cardiovascular (224 (3.9%) versus 215 (3.4%)) and alimentary tract and metabolism (30 (0.52%) versus 4 (0.06%)) classes had reduced over time. Participants in 2020-22 were significantly less likely than those in 2013-15 to have total ACB = 1 - 2 (odds ratio [95% confidence interval] = 0.473[0.385-0.581]) and ACB 3 (0.251[0.137 - 0.460]) compared to ACB = 0 after adjustment for potential confounders (p < 0.001). Although anticholinergic exposure has decreased over time, the use of medications with anticholinergic effects in the nervous system class has risen. This increase is attributable to antipsychotic use, which is of concern due to potential cardiovascular complications, and deserves further evaluation.

A - 2 Risk Factors for Reduced Mobility and Falls in Older Adults: the Role of Medication Use and Cognitive Impairment

Abstract Objective Sedative and anticholinergic (AC) medication use and cognitive impairment impose risk of gait imbalance and falls in older adults, but their combined effects on mobility have not been assessed. Method This cross-sectional study of 392 outpatients (age = 72 ± 7.7; 60.5%women; 93%White; education = 14 ± 3 years) characterized AC use (Anticholinergic Cognitive Burden Scale [ACB]) and number of sedative medications. Balance confidence (Activities-specific Balance Confidence Scale), walking decline compared to 5 years prior (0–3 scale), and recurrent falls (dichotomized by ≥2) were self-reported. Neuropsychological performance was averaged into a norm-adjusted composite (COG). T-tests and Pearson correlations assessed bivariate relationships across medication use, COG, and mobility. Multivariate models regressed falls, balance confidence, and gait changes (in separate models) on COG and medication use (ACs and sedatives examined separately), controlling for covariates. Results Most patients (70%–85%) used ≥1 sedative or AC medication. Few (12%) reported recurrent falls (range = 0–30), but balance confidence was reduced (M = 77.68 ± 21.31%) with mild walking declines reported (M = 1.34 ± 1.03). More sedative medication use and higher ACB scores were bivariately related to worse COG and mobility, and stronger COG was associated with better mobility (p’s ≤ 0.004). Worse COG (β = 0.196, p = 0.002) and more medication use, both sedatives (β = −0.246, p = 0.002) and ACB (β = −0.147, p = 0.047), independently predicted worse balance confidence. Higher ACB (β = 0.182, p = 0.022) and worse COG (β = −0.193, p = 0.007) uniquely predicted walking decline. Each sedative medication increased odds of falls by 27.4% (adjOR = 1.274, p = 0.034). Conclusion AC/sedative medication use and cognitive impairment pose complementary risks for compromised mobility. Clinicians should be alert to AC/sedative use and cognitive impairment in older patients at risk of falls.

A - 101 Anticholinergic Drug Use in Older Adults with Dementia: a Systematic Review

Abstract Objective This systematic review examined the prevalence of anticholinergic medication use, a known risk factor for cognitive impairment, among older adults with dementia. Data Selection PubMed and Embase were searched in February 2023 and March 2024 for studies reporting on the prevalence of anticholinergic medication use in older adults (age 65+) with a pre-existing diagnosis of dementia. We appraised 560 peer-reviewed manuscripts to determine they met inclusion criteria. The systematic review was conducted, designed and reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Results Twenty-nine studies met the inclusion criteria. Anticholinergic medication use rates among adults aged 65 or older with dementia ranged from 4.4% to 63.4% across studies. The median prevalence was 23.1%. In addition to several versions of the Beers Criteria and STOPP Criteria, a range of potentially inappropriate medication criteria were used. Conclusions Anticholinergic medications were widely used among older adults with dementia. Compared to a prior systematic review published in 2019, the current results indicate an increase in the frequency of anticholinergic use among older adults with dementia. Given the presence of cognitive impairment in this population, healthcare providers should closely monitor anticholinergic burden in their older adult patients and consult with prescribers to consider risks and benefits associated with such medications. Future research examining the prevalence of anticholinergic use among a broader population of older adults (e.g., those with mild cognitive impairment) appears warranted.