Anticholinergic burden in older adults with hyperpolypharmacy: a comparison of the drug burden index, anticholinergic cognitive burden, and duran scales in primary care

Abstract To evaluate anticholinergic burden in older adults (≥ 65 years) with hyperpolypharmacy (≥ 10 medications) in primary care using the Drug Burden Index (DBI), and to compare the results with those obtained using the Anticholinergic Cognitive Burden (ACB) scale and Duran’s scale. Additionally, factors associated with increased anticholinergic burden were explored. A multicenter cross-sectional study was conducted including 6,550 patients aged ≥ 65 years with hyperpolypharmacy in primary care settings. Sociodemographic, clinical, functional, and pharmacotherapeutic variables were obtained from electronic health records. Anticholinergic burden was assessed using the DBI, ACB, and Duran’s scales. Differences in burden according to patient characteristics were analyzed. Overall, 83.3% of patients were prescribed at least one medication with anticholinergic activity. According to the DBI, 50.2% of patients were classified as having a high anticholinergic burden, 44.2% as moderate burden, and 5.6% as having no risk. In contrast, the ACB scale classified 24.8% of patients as high risk, while Duran’s scale identified 27.2% as high risk. Mean DBI values were significantly higher among women, patients with dementia, individuals with greater cognitive and functional impairment, and those receiving ≥ 15 medications. Lorazepam and tramadol were the most frequently prescribed medications contributing to anticholinergic burden. Anticholinergic burden in older adults with hyperpolypharmacy varies substantially depending on the assessment tool used. The DBI identified a considerably higher burden than the ACB and Duran’s scales, reflecting important methodological differences among instruments. Systematic assessment of anticholinergic burden and regular medication review may help optimize pharmacotherapy and improve medication safety in this vulnerable population.