Development and Validity of an Algorithm for Reducing Anticholinergic Burden in Older Individuals in Primary Health Care

Rationale, Justification, and Objectives The cumulative effect of using drugs with anticholinergic activity is referred to as anticholinergic burden; when considered high, it is associated with adverse outcomes that impact the functionality of older individuals. This study aimed to develop and validate an algorithm for reducing the anticholinergic burden in older individuals to assist primary healthcare professionals in mitigating the anticholinergic risk to which these patients are exposed. Methods A study was conducted in five stages (development, review, content validity, face validity, and registration) between 2020 and 2024, based on a rigorous literature search and analysis. Face and content validity were performed using a modified Delphi method, and consensus among experts was measured by the Content Validity Index (CVI). Results The algorithm was developed by seven professionals and comprehends four steps: Step 1: Identifying the total anticholinergic burden being used; Step 2: Identifying drugs with anticholinergic activity eligible for deprescribing; Step 3: Identifying the use of the drugs amitriptyline, chlorpromazine, imipramine, paroxetine, and promethazine, and applying a flowchart to substitute them with drugs with a lower anticholinergic burden; Step 4: Providing additional guidance to assist in the choice of the drug, when to begin and how to use it. The face and content validity process occurred in two rounds, with the participation of eight experts in the first round and seven in the second, until a minimum CVI of 0.8 was achieved for all items. Conclusion This study led to the development and validity of an algorithm for reducing the anticholinergic burden in older individuals in primary health care to assist health professionals in reducing this population's risks.