Anticholinergic medicines - medication management, prescribing cascades, and deprescribing.

Abstract

This comment aims to raise awareness of the problems encountered when using anticholinergic burden (ACB) tools for the assessment of inappropriate medications (PIM), concerns related to prescribing cascades, and the process of deprescribing in patients older than 65 years. The first published tool, BEERS criteria from 1991, interpreted the ACB as the single biggest iatrogenic problem in treating older patients. Numerous subsequent publications repeated this interpretation rather than using real-world data. By comparing three internationally validated PIM tools (AGS BEERs criteria; EU(7)-PIM; PIM), this comment highlights how their anticholinergic (ACh) medicines lists differ, lack specific details on the strength of the ACh effect while also not providing suitable alternative pharmacological approaches. In addition, this comment considers the recognized contribution of ACh medicines in prescribing cascades and resultant inappropriate polypharmacy concerns while also considering barriers to deprescribing in the face of lacking detailed clinical guidance.