Observational studyJournal of the American Medical Directors Association2025
High Anticholinergic Burden of Patients Hospitalized for Hip Fracture Reveals a Target for Deprescribing.
Observational study in Journal of the American Medical Directors Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Anticholinergic burden and bone health in rheumatoid arthritis.Revista da Associacao Medica Brasileira (1992) · 2026Article
- Anticholinergic burden and postoperative mortality in older adults with hip fracture: a real-world observational study.Archives of orthopaedic and trauma surgery · 2025Observational
- Anticholinergic burden and polypharmacy in hospitalized urology patients: Prevalence and clinical implications.Indian journal of urology : IJU : journal of the Urological Society of IndiaArticle
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
objectivesAnticholinergic medications can produce harmful side effects, such as ataxia and delirium, in older adults. Older adults with hip fractures are particularly vulnerable, yet they are often prescribed these medications. This study aimed to evaluate the anticholinergic burden (ACB) before and after hospitalization for hip fracture, to identify potential targets for deprescribing.
designThis is an observational retrospective cohort study. Patients with hip fractures between 2012 and 2018 were identified from Medicare Provider Analysis data. Medications were identified from Medicare Part D claims at the time of fracture and from Omnicare claims 100 days post-discharge. The analysis focused on individuals with high pre-fracture ACB scores (≥3), as they had potential for deprescribing. SETTING AND
participantsThe study included individuals aged 66+ hospitalized for hip fractures who received post-acute care in Omnicare-contracted skilled nursing facilities.
methodsPre- and post-fracture ACB scores were calculated using the ACB scale. Patients were stratified by post-fracture ACB changes (increase, decrease, or no change). Demographics and comorbidities were described using means and percentages. The top 10 most prescribed anticholinergic medications with ACB score 2 or 3 were identified, and prescription rates were compared before and after fracture.
resultsOf 351,286 eligible patients, 138,966 (40%) had a high pre-fracture ACB score. The mean age was 83.5 years, and 78.9% were female. Post fracture, 42.6% of patients with a high ACB experienced a decrease in ACB, 9.9% had an increase, and 47.5% saw no change. Commonly prescribed anticholinergics included overactive bladder agents, antipsychotics, antidepressants, antihistamines, and opioids. CONCLUSIONS AND IMPLICATIONS: Forty percent of patients had a high ACB at fracture, and fewer than half experienced a decrease in ACB after fracture. Antipsychotics were overprescribed, and many patients remained on ineffective overactive bladder agents. There is a need for standardized deprescribing practices for patients with hip fractures in post-acute care settings.
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