Evaluation of anticholinergic burden in elderly patients

The elderly population has been increasing in the world, especially in recent years. As a result of age-related physiological, pharmacokinetic and pharmacodynamic changes, elderly patients are more vulnerable to side effects, possible drug-durg interactions and polypharmacy that develops as a natural consequence of the increase in the number of comorbidities. It is inevitable that elderly patients are exposed to drug burdens due to polypharmacy. Anticholinergic burden produces many undesirable side effects in the elderly patient. The aim of this thesis study is to determine the possible anticholinergic drugs besides the drugs with well-known anticholinergic effects, to evaluate the cumulative load, and to examine the effect of the anticholinergic burden on the falls in the elderly. Within the scope of this study, patients who applied to Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics and were using at least one anticholinergic effective drug were evaluated retrospectively between January-April 2021 and prospectively between May-August 2021 by the clinical pharmacist. The anticholinergic burden of the patients was determined by the anticholinergic cognitive burden scale. Aachen falls prevention scale was administered to each patient whose anticholinergic burden was determined in the prospective phase. A total of 601 patients (389 females) were included in the study. It has been determined that the risk of falling increases 2.50 times in patients with high anticholinergic burden (OR (95% CI) 2,503 (1,071-5,852) p=0.034), and the existing history of falling increases the risk of high anticholinergic burden 2.02 times (OR (95%CI) 2,026 (1,059-3,876) p=0,033). In addition, each unit increase in the fall scale score in the prospective part increases the risk of high anticholinergic burden by 22% (p=0,028). Anticholinergic burden was significantly reduced as a result of interventions by the clinical pharmacist in the prospective phase (p=0,01). It is very important that multidisciplinary team cooperates in detecting, reducing the anticholinergic burden and preventing possible side effects.