Anticholinergic and central nervous system-active drug burdens and their associations with adverse in-hospital outcomes among older inpatients.

AIM: Anticholinergic (ACh) and central nervous system (CNS)-active drug burdens may be associated with adverse outcomes in older adults. This study assessed these burdens and examined their associations with adverse in-hospital outcomes.

METHODS

A retrospective cross-sectional analysis was conducted among 13 607 hospitalizations in patients aged ≥60 years in 2024. ACh burden was assessed using the 2022 CRIDECO Anticholinergic Load Scale, and the 2023 Beers Criteria were used to assess CNS-active burden. For each exposure, hospitalizations were classified as having no, low, or high burden. The primary outcome was a composite of delirium, cognitive impairment, falls or fractures. Secondary outcomes included length of stay, in-hospital mortality and hospitalization costs. Separate multivariable regression models were used to estimate associations with ACh and CNS-active burdens.

RESULTS

Low and high ACh burdens were identified in 30.24% and 63.65% of hospitalizations, respectively; the corresponding proportions for CNS-active burden were 49.17% and 21.99%. Compared with no ACh burden, high ACh burden was associated with the primary outcome (adjusted odds ratio [aOR] 8.40; 95% confidence interval [CI] 3.46-20.38), whereas low ACh burden was not. Compared with no CNS-active burden, both low (aOR 4.67; 95% CI 2.67-8.18) and high (aOR 32.64; 95% CI 19.06-55.89) CNS-active burdens were also associated with this outcome. High burden in either group was associated with longer hospital stay, higher mortality and greater costs.

CONCLUSIONS

ACh and CNS-active burdens were associated with adverse in-hospital outcomes, supporting consideration of routine inpatient medication reviews to identify potentially harmful cumulative drug burden.