Original Articles
Vol. 11 No. 2 (2025)
https://doi.org/10.4081/gc.2025.14173

Anticholinergic and sedative medication burden in older adults: an observational analysis

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Received: 25 July 2025
Accepted: 22 October 2025
Published: 6 November 2025
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Anticholinergic agents, anticholinergic burden, drug burden index, older adults

Authors

Jehath Syed
https://orcid.org/0000-0002-9865-5894 (unauthenticated)
Department of Pharmaceutical Sciences, School of Health Sciences and Technology, Dr. Vishwanath Karad MIT World Peace University, Pune; Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Karnataka, India.
Prathibha Pereira
Department of Geriatrics, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Karnataka, India.
Tejaswini C J
Department of Geriatrics, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Karnataka, India.
Shilpa Avarebeel
Department of Geriatrics, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Karnataka, India.
Kshama Ramesh
Department of Geriatrics, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Karnataka, India.
Madhan Ramesh
Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Karnataka, India.
Krishna Undela
Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research Guwahati, India.
Sri Harsha Chalasani
sriharshachalasani@jssuni.edu.in
Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Karnataka, India.

The cumulative effects of multiple medications with anticholinergic and sedative properties, referred to as anticholinergic and sedative burdens, can result in adverse effects in older adults. This study aimed to evaluate the exposure of older adult patients to anticholinergic and sedative medications. This cross-sectional study included older adult patients (aged ≥60 years) admitted to the geriatric inpatient wards. The anticholinergic burden was assessed using the CRIDECO scale, and the Drug Burden Index (DBI) quantified the cumulative anticholinergic and sedative burden. The data obtained were categorically assessed and are represented as [n (%)]. The associations between medication burden and health outcomes were analyzed using appropriate tests. The mean age of the participants in the study cohort was 72.80±7.41 years. Among the participants, 29.17% were administered at least one anticholinergic medication, with a mean cumulative Anticholinergic Cognitive Burden (ACB) score of 2.49±2.00. The majority (94.34%) had a cumulative DBI score of ≥1, with a mean DBI score of 3.14±1.55. Linear regression analysis demonstrated that both ACB and DBI were significant predictors of the length of hospitalization (ACB: p=0.002; DBI: p=0.001), whereas only DBI was associated with the Charlson Comorbidity Index (p=0.001). Logistic regression revealed that ACB scores significantly predicted cognitive decline (p=0.047). This study highlights the high prevalence of anticholinergic and sedative medication use among hospitalized older adult patients and its association with adverse health outcomes. Regular medication reviews and targeted deprescribing strategies are essential to reduce the medication burden in this vulnerable population.

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Anticholinergic and sedative medication burden in older adults: an observational analysis. (2025). Geriatric Care, 11(2). https://doi.org/10.4081/gc.2025.14173
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