High Anticholinergic Burden of Patients Hospitalized for Hip Fracture Reveals a Target for Deprescribing.
Aidan P McAnena, Andrew R Zullo, Richa Joshi and 2 others
PMID 40058762WHAT IT FOUND
Among older hip fracture patients with high anticholinergic burden, 42.6% had lower burden during post-acute nursing home care, but 47.5% had no meaningful change and 9.9% increased.
Key findings
0140.0% of 423,347 Medicare beneficiaries with hip fracture had a high anticholinergic burden before fracture.
02Among those with high pre-fracture burden, anticholinergic burden decreased in 42.6%, did not change in 47.5%, and increased in 9.9% after fracture.
03The top 10 prescribed anticholinergics included overactive bladder agents, atypical antipsychotics, antidepressants, antihistamines, and an opioid analgesic, and each decreased after fracture.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study did not know why each medication was prescribed or changed. The results may not represent in-hospital changes in anticholinergic burden. The findings may not apply to people without Medicare fee-for-service insurance. Different anticholinergic burden scales may have produced different conclusions. The study did not determine whether the mechanism of injury affected burden changes. A 2-point change threshold may have missed smaller prescribing changes. It did not test whether lower burden improved delirium, falls, or recovery.
Declared interests
One author received Sanofi funding paid directly to Brown University for research on infections and vaccinations in nursing home residents. Another author receives royalties from Wolters-Kluwer for chapters on falls. No other authors reported conflicts of interest.
The easy way to misread this
Do not read the decrease in anticholinergic burden as proof that deprescribing improved delirium, falls, or recovery. This was an observational claims study, and it did not test whether lower burden helped patients.