Anticholinergic Burden at Admission and Discharge Among Geriatric Inpatients: A Single-Center Retrospective Cohort Study
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Background Anticholinergic medications are widely prescribed in older adults and contribute to cumulative anticholinergic burden (ACB), which is associated with adverse clinical outcomes. Hospitalized geriatric patients frequently experience multimorbidity and polypharmacy, increasing the risk of elevated ACB. Data from low- and middle-income settings, particularly at transitions of care, remain limited. Objective To assess prescribing patterns of medications with anticholinergic properties and quantify anticholinergic burden at admission and discharge among geriatric inpatients, and to evaluate its association with polypharmacy and clinical predictors. Methods A retrospective observational cohort study was conducted in the cardiology and nephrology departments of a tertiary care hospital in Islamabad, Pakistan, from January 2021 to December 2022. Patients aged ≥60 years with complete medication records were included. Anticholinergic burden was measured using the Anticholinergic Cognitive Burden (ACB) scale. Results A total of 1100 patients were analyzed (median age 65 years). Polypharmacy increased from 49.5% at admission to 84.5% at discharge (p<0.001). The proportion of patients with ACB ≥1 rose from 36.1% to 43.6% (p<0.001), and the median ACB score increased from 1 to 2 (p<0.001). Heart failure, renal disorders, higher comorbidity count, and longer hospital stay were independently associated with higher ACB at discharge. Male gender was associated with lower odds of ACB.
Abstract
Background Anticholinergic medications are widely prescribed in older adults and contribute to cumulative anticholinergic burden (ACB), which is associated with adverse clinical outcomes. Hospitalized geriatric patients frequently experience multimorbidity and polypharmacy, increasing the risk of elevated ACB. Data from low- and middle-income settings, particularly at transitions of care, remain limited. Objective To assess prescribing patterns of medications with anticholinergic properties and quantify anticholinergic burden at admission and discharge among geriatric inpatients, and to evaluate its association with polypharmacy and clinical predictors. Methods A retrospective observational cohort study was conducted in the cardiology and nephrology departments of a tertiary care hospital in Islamabad, Pakistan, from January 2021 to December 2022. Patients aged ≥60 years with complete medication records were included. Anticholinergic burden was measured using the Anticholinergic Cognitive Burden (ACB) scale. Results A total of 1100 patients were analyzed (median age 65 years). Polypharmacy increased from 49.5% at admission to 84.5% at discharge (p<0.001). The proportion of patients with ACB ≥1 rose from 36.1% to 43.6% (p<0.001), and the median ACB score increased from 1 to 2 (p<0.001). Heart failure, renal disorders, higher comorbidity count, and longer hospital stay were independently associated with higher ACB at discharge. Male gender was associated with lower odds of ACB. Conclusion Anticholinergic burden and polypharmacy are common and increase during hospitalization among geriatric patients. Targeted medication review at admission and discharge may help reduce cumulative anticholinergic exposure.