{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T02:16:37Z","timestamp":1783304197850,"version":"3.54.6"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:00:00Z","timestamp":1783209600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:00:00Z","timestamp":1783209600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100017170","name":"Thailand Science Research and Innovation","doi-asserted-by":"publisher","award":["2292"],"award-info":[{"award-number":["2292"]}],"id":[{"id":"10.13039\/501100017170","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Anticholinergic (ACh) and central nervous system (CNS)\u2010active drug burdens may be associated with adverse outcomes in older adults. This study assessed these burdens and examined their associations with adverse in\u2010hospital outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cross\u2010sectional analysis was conducted among 13\u2009607 hospitalizations in patients aged \u226560\u2009years in 2024. ACh burden was assessed using the 2022 CRIDECO Anticholinergic Load Scale, and the 2023 Beers Criteria were used to assess CNS\u2010active burden. For each exposure, hospitalizations were classified as having no, low, or high burden. The primary outcome was a composite of delirium, cognitive impairment, falls or fractures. Secondary outcomes included length of stay, in\u2010hospital mortality and hospitalization costs. Separate multivariable regression models were used to estimate associations with ACh and CNS\u2010active burdens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Low and high ACh burdens were identified in 30.24% and 63.65% of hospitalizations, respectively; the corresponding proportions for CNS\u2010active burden were 49.17% and 21.99%. Compared with no ACh burden, high ACh burden was associated with the primary outcome (adjusted odds ratio [aOR] 8.40; 95% confidence interval [CI] 3.46\u201320.38), whereas low ACh burden was not. Compared with no CNS\u2010active burden, both low (aOR 4.67; 95% CI 2.67\u20138.18) and high (aOR 32.64; 95% CI 19.06\u201355.89) CNS\u2010active burdens were also associated with this outcome. High burden in either group was associated with longer hospital stay, higher mortality and greater costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ACh and CNS\u2010active burdens were associated with adverse in\u2010hospital outcomes, supporting consideration of routine inpatient medication reviews to identify potentially harmful cumulative drug burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bcp.70682","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T02:04:53Z","timestamp":1783303493000},"source":"Crossref","is-referenced-by-count":0,"title":["Anticholinergic and central nervous system\u2010active drug burdens and their associations with adverse in\u2010hospital outcomes among older inpatients"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9519-5434","authenticated-orcid":false,"given":"Kittipak","family":"Jenghua","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Care, School of Pharmaceutical Sciences University of Phayao  Phayao Thailand"},{"name":"Pharmacoepidemiology, Social and Administrative Pharmacy (PSAP) Research Unit, School of Pharmaceutical Sciences University of Phayao  Phayao Thailand"},{"name":"Research on Drug Utilization in Special Populations (RDU\u2010SPEC) Research Unit, School of Pharmaceutical Sciences University of Phayao  Phayao Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2945-5900","authenticated-orcid":false,"given":"Jariya","family":"Ratcharoen","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, School of Pharmaceutical Sciences University of Phayao  Phayao Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6496-9470","authenticated-orcid":false,"given":"Thidapon","family":"Wannathong","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, School of Pharmaceutical Sciences University of Phayao  Phayao Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7909-366X","authenticated-orcid":false,"given":"Awitra","family":"Phumsod","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, School of Pharmaceutical Sciences University of Phayao  Phayao Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0971-5239","authenticated-orcid":false,"given":"Chantra","family":"Khumsorn","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, School of Pharmaceutical Sciences University of Phayao  Phayao Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2650-1121","authenticated-orcid":false,"given":"Noppaket","family":"Singkham","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, School of Pharmaceutical Sciences University of Phayao  Phayao Thailand"},{"name":"Research on Drug Utilization in Special Populations (RDU\u2010SPEC) Research Unit, School of Pharmaceutical Sciences University of Phayao  Phayao Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2603-2142","authenticated-orcid":false,"given":"Duangkamon","family":"Poolpun","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Buddhachinaraj Hospital  Phitsanulok Province Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,5]]},"reference":[{"issue":"28","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"604","DOI":"10.46234\/ccdcw2021.160","article-title":"Major trends in population growth around the world","volume":"3","author":"Gu D","year":"2021","journal-title":"China CDC Wkly"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/23337214241280422","article-title":"Developing and evaluating a program to support preparation for aging: a case study from Phuket Province, Thailand","volume":"10","author":"Luevanich C","year":"2024","journal-title":"Gerontol Geriatr Med"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262\u2010024\u201001466\u20100"},{"issue":"7","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1111\/jgs.18372","article-title":"American Geriatrics Society 2023 updated AGS Beers Criteria\u00ae for potentially inappropriate medication use in older adults","volume":"71","author":"By the 2023 American Geriatrics Soceity Beers Criteria Update Expert Panel","year":"2023","journal-title":"J Am Geriatr Soc"},{"issue":"8","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.26910","article-title":"Prevalence of use of potentially inappropriate medications among older adults worldwide: a systematic review and meta\u2010analysis","volume":"6","author":"Tian F","year":"2023","journal-title":"JAMA Netw Open"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2024.104959"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010025\u201005967\u2010w"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018\u2010022\u201003222\u20101"},{"issue":"2","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3390\/jpm12020207","article-title":"CRIDECO anticholinergic load scale: an updated anticholinergic burden scale. Comparison with the ACB scale in Spanish individuals with subjective memory complaints","volume":"12","author":"Ramos H","year":"2022","journal-title":"J Pers Med"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228\u2010020\u201002994\u2010x"},{"issue":"6","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s40266-025-01204-6","article-title":"Comparison of anticholinergic burden scales and their association with cognitive and functional impairment in older adults: a cross\u2010sectional study using the REPOSI database","volume":"42","author":"Novella A","year":"2025","journal-title":"Drugs Aging"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12123897"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.70049"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41999\u2010021\u201000479\u20103"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010024\u201005394\u20103"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jeph.2024.202744"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010021\u201001492\u20107"},{"key":"e_1_2_11_19_1","first-page":"1","article-title":"The concise guide to PHARMACOLOGY 2021\/22: G protein\u2010coupled receptors","volume":"178","author":"Alexander SPH","year":"2021","journal-title":"Br J Pharmacol"},{"key":"e_1_2_11_20_1","first-page":"1","article-title":"The concise guide to PHARMACOLOGY 2021\/22: ion channels","volume":"178","author":"Alexander SPH","year":"2021","journal-title":"Br J Pharmacol"},{"issue":"9","key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/s00228-021-03125-w","article-title":"Anticholinergic load and delirium in end\u2010of\u2010life patients","volume":"77","author":"Pasina LRB","year":"2021","journal-title":"Eur J Clin Pharmacol"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.16262"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0332946"},{"key":"e_1_2_11_24_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1002\/agm2.12250","article-title":"Polypharmacy and cumulative anticholinergic burden in older adults hospitalized with fall","volume":"6","author":"Wong HL","year":"2023","journal-title":"Aging Med"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2024.1369200"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12617"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.871229"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010023\u201004599\u20102"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.57264\/cer\u20102025\u20100054"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010025\u201023079\u20108"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010026\u201037555\u20102"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17508"},{"issue":"9","key":"e_1_2_11_33_1","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1177\/13524585241251986","article-title":"Trends in central nervous system\u2010active polypharmacy among people with multiple sclerosis","volume":"30","author":"Naizer HWJ","year":"2024","journal-title":"Mult Scler"}],"container-title":["British Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bcp.70682","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/bcp.70682","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bcp.70682","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T02:05:02Z","timestamp":1783303502000},"score":1,"resource":{"primary":{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/10.1002\/bcp.70682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,5]]},"references-count":32,"alternative-id":["10.1002\/bcp.70682"],"URL":"https:\/\/doi.org\/10.1002\/bcp.70682","archive":["Portico"],"relation":{},"ISSN":["0306-5251","1365-2125"],"issn-type":[{"value":"0306-5251","type":"print"},{"value":"1365-2125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,5]]},"article-number":"bcp.70682"}}