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Background <p>Delirium is a frequent cause of admission to the emergency department (ED) for older patients. Iatrogenic morbidity, particularly the hidden anticholinergic effects of many treatments, plays a significant role. The clinical impact of AB reduction on early rehospitalization remains unclear. However, reducing the anticholinergic burden (AB) of medical prescriptions (MP) could be beneficial for patients.</p> Objective <p>This study primarily aimed to investigate whether reducing AB during hospitalization influences early rehospitalization rates (within 30 days) in older patients admitted for delirium. As a secondary objective, we sought to identify factors associated with AB reduction during hospitalization.</p> Methods <p>This retrospective cross-sectional study was conducted at Tours University Hospital (TUH). We included 160 patients aged 75 years and older hospitalized via the ED for delirium. Patients were divided into two groups based on AB variation at discharge: decreased AB or stable/increased AB. The Anticholinergic Impregnation Coefficient (AIC) was used to measure AB. Multivariable analysis was performed to assess associations between AB reduction and clinical outcomes.</p> Results <p>Of the 160 patients, 51 (31.9%) had a decreased AB at discharge, while 109 (68.1%) had a stable or increased AB. Early rehospitalization occurred in 20 (12.5%) patients, with a lower rate in the decreased AB group (3.9% vs. 16.5%). However, AB reduction did not significantly influence early rehospitalization risk in multivariable analysis. Medication reconciliation at admission was significantly associated with AB reduction (<i>p</i> &lt; 0.05).(ORa = 0.21 [0.08–0.52]).</p> Conclusions <p>While reducing AB did not significantly alter early rehospitalization rates, this study highlights the critical role of medication reconciliation at admission in optimizing medication management for older patients with delirium. Future research should explore comprehensive, multidisciplinary strategies to reduce rehospitalizations in this vulnerable population.</p>

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Factors influencing the anticholinergic burden of medical prescriptions for older patients hospitalized for delirium

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月31日

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  • Vincent Garrouste,
  • Helene Bassac,
  • Julie Bourgueil,
  • Camille Debacq,
  • Amal Aidoud,
  • Romain Jouffroy,
  • Victoire Leroy,
  • Pascal Blanc,
  • Bertrand Fougère,
  • Matthieu Coulongeat

摘要

Background

Delirium is a frequent cause of admission to the emergency department (ED) for older patients. Iatrogenic morbidity, particularly the hidden anticholinergic effects of many treatments, plays a significant role. The clinical impact of AB reduction on early rehospitalization remains unclear. However, reducing the anticholinergic burden (AB) of medical prescriptions (MP) could be beneficial for patients.

Objective

This study primarily aimed to investigate whether reducing AB during hospitalization influences early rehospitalization rates (within 30 days) in older patients admitted for delirium. As a secondary objective, we sought to identify factors associated with AB reduction during hospitalization.

Methods

This retrospective cross-sectional study was conducted at Tours University Hospital (TUH). We included 160 patients aged 75 years and older hospitalized via the ED for delirium. Patients were divided into two groups based on AB variation at discharge: decreased AB or stable/increased AB. The Anticholinergic Impregnation Coefficient (AIC) was used to measure AB. Multivariable analysis was performed to assess associations between AB reduction and clinical outcomes.

Results

Of the 160 patients, 51 (31.9%) had a decreased AB at discharge, while 109 (68.1%) had a stable or increased AB. Early rehospitalization occurred in 20 (12.5%) patients, with a lower rate in the decreased AB group (3.9% vs. 16.5%). However, AB reduction did not significantly influence early rehospitalization risk in multivariable analysis. Medication reconciliation at admission was significantly associated with AB reduction (p < 0.05).(ORa = 0.21 [0.08–0.52]).

Conclusions

While reducing AB did not significantly alter early rehospitalization rates, this study highlights the critical role of medication reconciliation at admission in optimizing medication management for older patients with delirium. Future research should explore comprehensive, multidisciplinary strategies to reduce rehospitalizations in this vulnerable population.