Interventions to reduce anticholinergic burden in adults aged 65 and older: A systematic review

Athagran Nakham, Phyo K. Myint, Christine M. Bond, Rumana Newlands, Yoon K. Loke, Moira Cruickshank* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)
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Older age is associated with multimorbidity and polypharmacy with high anticholinergic burden (ACB). High ACB is linked to adverse events such as poor physical functioning, dementia, cardiovascular disease, and falls. Interventions are needed to reduce this burden.

The aim was to systematically review the literature to identify and describe studies of clinical and cost-effectiveness of interventions designed to reduce ACB in adults (≥65 years) on polypharmacy regimes, compared with usual care. The objective was to answer the following questions: What are the contents of the interventions? Were these interventions clinically effective? Were these interventions cost effective?.

Design, setting, and participants
Systematic review of interventions to reduce anticholinergic burden in adults aged 65 and older in any clinical setting.

Eligible papers reported primary or secondary research describing any type of intervention including systematic reviews, randomized controlled trials (RCTs), controlled clinical trials, or nonrandomized pre-post intervention studies (PPIs) published in English from January 2010 to February 2019. Databases searched included CINAHL, Ovid MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials (CENTRAL).

The search yielded 5862 records. Eight studies (4 RCTs, 4 PPIs) conducted in hospital (4), community (2), nursing homes (1), and retirement villages (1) met the inclusion criteria. Pharmacists, either individually or as part of a team, provided the intervention in the majority of studies (6/8). Most (7/8) involved individual patient medication review followed by feedback to the prescriber. Two of the 4 RCTs and all non-RCTs reported a decrease in ACB following the intervention. No study reported cost outcome.

Pharmacists may be well placed to implement an ACB reduction intervention. This is the first systematic review of interventions to reduce ACB in older adults, and it highlights the need for development and testing of high-quality pragmatic clinical and cost-effectiveness trials in community and specific patient populations at high risk of harm from ACB.

[PROSPERO registration: CRD42018089764].
Original languageEnglish
Pages (from-to)172-180.e5
Number of pages9
JournalJournal of the American Medical Directors Association
Issue number2
Early online date24 Jul 2019
Publication statusPublished - Feb 2020

Bibliographical note

We would like to give special thanks to Dr Carrie Stewart for her contribution in manuscript drafting. We gratefully acknowledge Ministry of Science and Technology, the Thai Royal Government Scholarship support towards AN and the study team was also supported by The Dunhill Medical Trust [grant number RPGF1806/66] funds towards PKM and YKL as part of the project entitled “An evidence synthesis suite to inform a future randomised trial of reducing anticholinergic related harm in older adults”. The funders had no role in study design or interpretation of the results.


  • intervention
  • anticholinergic burden
  • inappropriate prescribing
  • older adult
  • Intervention
  • RISK


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