Abstract
BACKGROUND: Drugs with anticholinergic (AC) effects can cause adverse reactions such as dry mouth, blurred vision, urinary retention, and cognitive impairment, and have been linked to poorer health outcomes, including reduced quality of life, higher mortality, and longer hospital stays. Older adults are particularly susceptible due to age-related changes, and polypharmacy may further increase risk. While tools exist to identify anticholinergic burden (ACB), real-world management remains challenging. Pharmacist-led or multidisciplinary reviews can reduce ACB, but such interventions are uncommon in rural community settings and often overlook patients' perspectives, despite evidence supporting patient-centered approaches. OBJECTIVES: AC drugs can increase ACB and have negative effects on older adults. This study evaluated the impact of interdisciplinary pharmaceutical care integrated with older adults' engagement on reducing ACB in rural communities. DESIGN: Subgroup analysis of the Healthy Longevity and Aging in Place community-based cluster-randomized controlled trial conducted in rural Yunlin, Taiwan, focusing on the pharmaceutical care component for residents aged ⩾50 years. METHODS: Communities were randomized (1:1) to receive either an interdisciplinary pharmaceutical care program or usual care. The care team, comprising physicians, pharmacists, and nurses, reviewed participants' medications, categorized AC drugs as for chronic disease control (R-type) or symptom relief (S-type), and delivered patient-specific recommendations, education, and follow-up over 6 months. The primary outcome was the proportion of AC drug discontinuation at 6 months. RESULTS: Three hundred and forty-six community-dwelling older adults were included in the analyses; 56% of the elderly were prescribed AC drugs, and 337 AC drugs were analyzed. After 6 months of intervention, the pharmaceutical care group had a higher overall discontinuation rate (22%) compared with the usual care group (14%); while this difference was not statistically significant (p = 0.063), the trend may have clinical relevance. Noteworthy, the discontinuation rate of the S-type AC drugs was significantly higher in the pharmaceutical care group (60%) than the usual care group (36%, p = 0.029). Famotidine, tramadol, alprazolam, and celecoxib were the most commonly prescribed and discontinued S-type AC drugs. CONCLUSION: This community-based interdisciplinary pharmaceutical care model, which included patient participation, was effective in reducing the burden of S-type AC drugs among older adults in rural communities.