Predictors and prescribing patterns of definite anticholinergic medication use among community-dwelling older adults in Saudi Arabia: a retrospective multicenter cross-sectional study
8 affiliations
- 1Department of Pharmacy Practice, College of Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- 2Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
- 3Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, United States
- 4Department of Pharmacy Practice, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
- 5Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
- 6Department of Pharmacy Practice, College of Pharmacy, Najran University, Najran, Saudi Arabia
- 7Clinical Trial Unit, Translational Medical Research Center, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- 8Department of Psychiatry, Imam Abdulrahman Bin Faisal Hospital, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia
Abstract
Background/objectives: Anticholinergic medications are associated with cognitive impairment and falls in older adults, yet multicenter evidence from Saudi Arabia remains limited. This study characterized prescribing patterns and factors associated with definite anticholinergic burden among older adults receiving outpatient care.
Methods: This retrospective multicenter cross-sectional study used outpatient records and dispensing data from two tertiary hospitals located in Al Khobar and Al-Ahsa, Saudi Arabia, between 2019 and 2024. Adults aged 60 years or older receiving at least one medication scoring 2 or 3 on the Anticholinergic Cognitive Burden (ACB) scale were included. Robust linear, negative binomial, and logistic regression models examined definite ACB score, additional qualifying medications, and multiple medication use.
Results: The study included 1,664 older adults with 2016 patient-medication instances. Polypharmacy was present in 84.3%, and 17.5% received multiple qualifying medications. Bladder antimuscarinics, antipsychotics, and tricyclic antidepressants accounted for 78.1% of medication instances, while urology, psychiatry, and neurology accounted for 72.0%. A corresponding coded diagnosis was identified for 20.0% of evaluable instances. Polypharmacy, hypertension, depression, Parkinson's disease, schizophrenia, and bipolar disorder were independently associated with all three outcomes. Schizophrenia showed the strongest associations with definite ACB score (B = 2.206; 95% CI, 0.429–3.982), additional medications (incidence rate ratio = 4.395; 95% CI, 2.499–7.732), and multiple medication use (adjusted odds ratio = 8.303; 95% CI, 3.275–21.055).
Conclusions: Definite anticholinergic use was concentrated within a limited number of medication classes and prescribing specialties. Psychiatric disorders and polypharmacy were consistently associated with higher burden, supporting targeted medication review in these patients and specialties.
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BibTeX
@article{alamer2026predictors,
title = {{Predictors and prescribing patterns of definite anticholinergic medication use among community-dwelling older adults in Saudi Arabia: a retrospective multicenter cross-sectional study}},
author = {Khalid A. Alamer and Mohamed A. Albekery and Noha Keshk and Fawaz M. Alotaibi and Ibrahim S. Alhomoud and Ali H. Alwadai and Mansour M. Alotaibi and Ahmad M. Almuslim and Ali H. Nasfan and Munthir Abdulmajeed Aldukhi and Turki Aldossary and Nemer AlMosyab and Khaled S. Alnaim and Wassan A. Alnaim and Yasser A. Alharbi and Mohammed Y. Shabib and Rawan M. Alhulibi and Norah A. Alayesh},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1974639},
url = {https://doi.org/10.3389/fmed.2026.1974639},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Predictors and prescribing patterns of definite anticholinergic medication use among community-dwelling older adults in Saudi Arabia: a retrospective multicenter cross-sectional study
AU - Khalid A. Alamer
AU - Mohamed A. Albekery
AU - Noha Keshk
AU - Fawaz M. Alotaibi
AU - Ibrahim S. Alhomoud
AU - Ali H. Alwadai
AU - Mansour M. Alotaibi
AU - Ahmad M. Almuslim
AU - Ali H. Nasfan
AU - Munthir Abdulmajeed Aldukhi
AU - Turki Aldossary
AU - Nemer AlMosyab
AU - Khaled S. Alnaim
AU - Wassan A. Alnaim
AU - Yasser A. Alharbi
AU - Mohammed Y. Shabib
AU - Rawan M. Alhulibi
AU - Norah A. Alayesh
PY - 2026
DA - 2026/10/13
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1974639
UR - https://doi.org/10.3389/fmed.2026.1974639
AB - Background/objectives: Anticholinergic medications are associated with cognitive impairment and falls in older adults, yet multicenter evidence from Saudi Arabia remains limited. This study characterized prescribing patterns and factors associated with definite anticholinergic burden among older adults receiving outpatient care. Methods: This retrospective multicenter cross-sectional study used outpatient records and dispensing data from two tertiary hospitals located in Al Khobar and Al-Ahsa, Saudi Arabia, between 2019 and 2024. Adults aged 60 years or older receiving at least one medication scoring 2 or 3 on the Anticholinergic Cognitive Burden (ACB) scale were included. Robust linear, negative binomial, and logistic regression models examined definite ACB score, additional qualifying medications, and multiple medication use. Results: The study included 1,664 older adults with 2016 patient-medication instances. Polypharmacy was present in 84.3%, and 17.5% received multiple qualifying medications. Bladder antimuscarinics, antipsychotics, and tricyclic antidepressants accounted for 78.1% of medication instances, while urology, psychiatry, and neurology accounted for 72.0%. A corresponding coded diagnosis was identified for 20.0% of evaluable instances. Polypharmacy, hypertension, depression, Parkinson's disease, schizophrenia, and bipolar disorder were independently associated with all three outcomes. Schizophrenia showed the strongest associations with definite ACB score (B = 2.206; 95% CI, 0.429–3.982), additional medications (incidence rate ratio = 4.395; 95% CI, 2.499–7.732), and multiple medication use (adjusted odds ratio = 8.303; 95% CI, 3.275–21.055). Conclusions: Definite anticholinergic use was concentrated within a limited number of medication classes and prescribing specialties. Psychiatric disorders and polypharmacy were consistently associated with higher burden, supporting targeted medication review in these patients and specialties.
SN - 2296-858X
ER -