The effectiveness of a multidisciplinary frailty team in reducing anticholinergic burden in frail older patients

Increasing evidence suggests drugs known to have anticholinergic properties are an important safety concern in frail older patients and are known to cause cognitive and physical impairment.1,2,3 Prevalent medications such as antimuscarinics, psychotropic drugs and antihistamines amongst others have been demonstrated to possess anticholinergic activity.4 These drugs are commonly used for conditions such as urinary incontinence, behavioural and psychological symptoms of dementia and vertigo. Anticholinergic agents block the neurotransmitter acetylcholine in the peripheral and central nervous systems, resulting in inhibition of parasympathetic nerve impulses causing delirium, constipation, dry mouth and agitation.5 Although useful in conditions such as those highlighted above, adverse outcomes such as falls, cognitive decline, delirium and increased mortality are frequently overlooked and underestimated by prescribers.6 Unwanted anticholinergic activity is often referred to as ‘burden’ and interventions to reduce this burden may provide benefit.