Key result
Hospitalization linked to an ~8% absolute increase in anticholinergic burden among geriatric inpatients.
Why the study?
Anticholinergic burden carries adverse outcomes in hospitalized older adults with multimorbidity and polypharmacy, but data from low- and middle-income settings at care transitions remain limited.
Does hospitalization increase anticholinergic burden and polypharmacy among geriatric inpatients?
Cohort (n=1,100)
No
Does hospitalization increase anticholinergic burden and polypharmacy among geriatric inpatients?
Hospitalization of geriatric patients is associated with a significant increase in polypharmacy and cumulative anticholinergic burden at discharge compared to admission.
Answers are grounded in this paper and cite their sources.
High ACB common and rises during hospitalization in geriatric inpatients; leaves open whether deprescribing improves outcomes in LMIC settings.
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.
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Akhtar et al. (2026) conducted a cohort in Geriatric inpatients with chronic conditions (n=1,100). Hospitalization vs. Admission (baseline) was evaluated on Proportion of patients with anticholinergic burden (ACB score ≥1) (7.5% net increase, p=<0.001). Hospitalization significantly increased the proportion of geriatric inpatients with an anticholinergic burden (ACB score ≥1) from 36.1% at admission to 43.6% at discharge.
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