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Effectiveness of interventions to improve the anticholinergic prescribing practice in older adults: a systematic review


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Salahudeen, MS ORCID: 0000-0001-9131-7465, Alfahmi, A, Farooq, A, Akhtar, M, Ajaz, S, Alotaibi, S, Faiz, M and Ali, S ORCID: 0000-0001-9557-0345 2022 , 'Effectiveness of interventions to improve the anticholinergic prescribing practice in older adults: a systematic review' , Journal of Clinical Medicine, vol. 11, no. 3 , pp. 1-18 , doi: 10.3390/jcm11030714.

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Background: Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and there is no specific intervention strategy for reducing drug burden from anticholinergic activity medications. Little is known about the effectiveness of current interventions that may likely improve the anticholinergic prescribing practice in older adults. Aims: This review seeks to document all types of interventions aiming to reduce anticholinergic prescribing among older adults and assess the current evidence and quality of existing single and combined interventions. Methods: We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO from January 1990 to August 2021. Only studies that examined the effect of interventions in older people focused on improving compliance with anticholinergic prescribing guidelines with quantifiable data were included. The primary outcome of interest was to find the effectiveness of interventions that enhance the anticholinergic prescribing practice in older adults. Results: We screened 3168 records and ended up in 23 studies that met the inclusion criteria. We found only single-component interventions to reduce anticholinergic prescribing errors in older people. Pharmacists implemented interventions without collaboration in nearly half of the studies (n = 11). Medication review (43%) and education provision (26%) to healthcare practitioners were the most common interventions. Sixteen studies (70%) reported significant reductions in anticholinergic prescribing errors, whereas seven studies (30%) showed no significant effect. Conclusion: This systematic review suggests that healthcare practitioner-oriented interventions have the potential to reduce the occurrence of anticholinergic prescribing errors in older people. Interventions were primarily effective in reducing the burden of anticholinergic medications and assisting with deprescribing anticholinergic medications in older adults.

Item Type: Article
Authors/Creators:Salahudeen, MS and Alfahmi, A and Farooq, A and Akhtar, M and Ajaz, S and Alotaibi, S and Faiz, M and Ali, S
Keywords: anticholinergics, intervention, prescribing, older people
Journal or Publication Title: Journal of Clinical Medicine
Publisher: MDPIAG
ISSN: 2077-0383
DOI / ID Number: 10.3390/jcm11030714
Copyright Information:

© 2022. The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) License ( The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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