{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T06:00:50Z","timestamp":1785477650202,"version":"3.56.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Assessing cumulative anticholinergic exposure is essential in geriatric pharmacotherapy and medication safety. The present study aimed to provide real-world evidence on this issue in community-dwelling older adults. The objectives were: (i) to determine the prevalence of anticholinergic medication use; (ii) to analyze factors related to this use; and (iii) to assess the agreement between the scales applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter cross-sectional study included 365 participants aged 65 years or older, recruited from nine urban primary healthcare centers in the city of M\u00e1laga (Andalusia, Spain), using stratified random sampling. Anticholinergic burden was calculated for all regular medications taken by participants through the application of five scales: the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Risk Scale (ARS), Anticholinergic Drug Scale (ADS), Anticholinergic Burden Classification (ABC), and Drug Burden Index (DBI). Factors associated with the rate of anticholinergic medication use were examined using a multivariable quasi-Poisson regression model with the total number of medications included as an offset. Pairwise agreement for any anticholinergic exposure between scales was assessed using contingency tables and Cohen\u2019s kappa coefficient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 74.2% of participants were taking one or more medications with anticholinergic properties according to at least one scale. However, relevant differences were observed across the assessment instruments. Only moderate agreement was found between ADS and DBI (\u03ba = 0.48) and between ADS and ACB (\u03ba = 0.44); all other pairwise comparisons showed weak or very weak agreement. Anxiolytics\/hypnotics (mainly benzodiazepines), antidepressants, urological antispasmodics, antihistamines, opioid analgesics, antipsychotics, and antiepileptic drugs were the therapeutic classes most frequently contributing to anticholinergic exposure. The rate of anticholinergic medication use was 30.5% higher in patients with any mental health condition, mainly anxiety and\/or depression, than in those without such diagnoses (Rate Ratio = 1.305, 95% CI: 1.127\u20131.511).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study found a high prevalence of exposure to medications with anticholinergic activity among community-dwelling older adults. Although more than 50 medications were identified by the applied tools, benzodiazepines represented the therapeutic class most frequently contributing to patients\u2019 anticholinergic burden. Clinicians should be familiar with the available tools to identify high-risk medications, consider safer alternatives, and support more appropriate prescribing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1886899","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:38:52Z","timestamp":1785476332000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Anticholinergic burden in community-dwelling older adults: prevalence, associated factors, and agreement between measurement scales"],"prefix":"10.3389","volume":"17","author":[{"given":"Francisco De Borja","family":"Rodr\u00edguez-Salas","sequence":"first","affiliation":[{"name":"Servicio Andaluz de Salud, Health District of M\u00e1laga-Guadalhorce","place":["M\u00e1laga, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Angeles","family":"Merch\u00e1n-Cruz","sequence":"additional","affiliation":[{"name":"Servicio Andaluz de Salud, Health District of M\u00e1laga-Guadalhorce","place":["M\u00e1laga, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Oca\u00f1a-Riola","sequence":"additional","affiliation":[{"name":"Escuela Andaluza de Salud P\u00fablica","place":["Granada, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar Mar\u00eda","family":"D\u00edez-de-Balde\u00f3n-Chic\u00f3n","sequence":"additional","affiliation":[{"name":"Servicio Andaluz de Salud, Health District of M\u00e1laga-Guadalhorce","place":["M\u00e1laga, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Pablo","family":"Lara","sequence":"additional","affiliation":[{"name":"IBIMA Plataforma BIONAND, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga","place":["M\u00e1laga, Spain"]},{"name":"Brain Health Unit, School of Medicine, Centre for Medical and Health Research (CIMES), University of M\u00e1laga","place":["M\u00e1laga, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Encarnaci\u00f3n","family":"Blanco-Reina","sequence":"additional","affiliation":[{"name":"IBIMA Plataforma BIONAND, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga","place":["M\u00e1laga, Spain"]},{"name":"Pharmacology and Therapeutics Department, School of Medicine, University of M\u00e1laga","place":["M\u00e1laga, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"B1","volume-title":"Foundations of Linear and Generalized Linear Models","author":"Agresti","year":"2015"},{"key":"B2","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1007\/s00228-019-02795-x","article-title":"Association between anticholinergic drug burden and mortality in older people: a systematic review","volume":"76","author":"Ali","year":"2020","journal-title":"Eur. 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