INTRODUCTION Older age is associated with multimorbidity and polypharmacy with high anticholinergic burden (ACB). High ACB is linked to adverse events such as poor physical functioning, dementia, cardiovascular disease, and falls. Interventions are needed to reduce this burden. AIMS/OBJECTIVES The aim was to systematically review the literature to identify and describe studies of clinical and cost-effectiveness of interventions designed to reduce ACB in adults (≥65 years) on polypharmacy regimes, compared with usual care. The objective was to answer the following questions: What are the contents of the interventions? Were these interventions clinically effective? Were these interventions cost effective?. DESIGN, SETTING, AND PARTICIPANTS Systematic review of interventions to reduce anticholinergic burden in adults aged 65 and older in any clinical setting. METHODS Eligible papers reported primary or secondary research describing any type of intervention including systematic reviews, randomized controlled trials (RCTs), controlled clinical trials, or nonrandomized pre-post intervention studies (PPIs) published in English from January 2010 to February 2019. Databases searched included CINAHL, Ovid MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials (CENTRAL). RESULTS The search yielded 5862 records. Eight studies (4 RCTs, 4 PPIs) conducted in hospital (4), community (2), nursing homes (1), and retirement villages (1) met the inclusion criteria. Pharmacists, either individually or as part of a team, provided the intervention in the majority of studies (6/8). Most (7/8) involved individual patient medication review followed by feedback to the prescriber. Two of the 4 RCTs and all non-RCTs reported a decrease in ACB following the intervention. No study reported cost outcome. CONCLUSIONS/IMPLICATIONS Pharmacists may be well placed to implement an ACB reduction intervention. This is the first systematic review of interventions to reduce ACB in older adults, and it highlights the need for development and testing of high-quality pragmatic clinical and cost-effectiveness trials in community and specific patient populations at high risk of harm from ACB. [PROSPERO registration: CRD42018089764].

中文翻译：

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减少 65 岁及以上成人抗胆碱能负担的干预措施：系统评价

引言 高龄与多发病和多重用药相关，抗胆碱能负荷 (ACB) 较高。高 ACB 与不良事件有关，例如身体机能不良、痴呆、心血管疾病和跌倒。需要采取干预措施来减轻这种负担。目的/目标 目的是系统地回顾文献，以确定和描述旨在减少成人（≥65 岁）使用多种药物治疗的 ACB 的干预措施的临床和成本效益研究，与常规治疗相比。目的是回答以下问题：干预的内容是什么？这些干预措施在临床上有效吗？这些干预措施是否具有成本效益？设计，设置，和参与者 在任何临床环境中对减少 65 岁及以上成人抗胆碱能负担的干预措施进行系统评价。方法 符合条件的论文报告了描述任何类型干预措施的主要或次要研究，包括系统评价、随机对照试验 (RCT)、对照临床试验或 2010 年 1 月至 2019 年 2 月以英文发表的非随机干预前研究 (PPI)。 数据库检索包括 CINAHL、Ovid MEDLINE、EMBASE 和 Cochrane 对照试验中央注册中心 (CENTRAL)。结果 搜索产生了 5862 条记录。在医院 (4)、社区 (2)、疗养院 (1) 和退休村 (1) 进行的八项研究（4 个 RCT，4 个 PPI）符合纳入标准。药剂师，无论是个人还是团队的一部分，在大多数研究 (6/8) 中提供了干预。大多数 (7/8) 涉及个体患者用药审查，然后反馈给开药者。4 个 RCT 中的两个和所有非 RCT 报告干预后 ACB 下降。没有研究报告成本结果。结论/影响 药剂师可以很好地实施 ACB 减少干预。这是对减少老年人 ACB 干预措施的第一次系统评价，它强调了在社区和特定患者人群中开发和测试高质量的实用临床和成本效益试验的必要性，这些试验面临 ACB 危害的高风险。[PROSPERO 注册：CRD42018089764]。4 个 RCT 中的两个和所有非 RCT 报告干预后 ACB 下降。没有研究报告成本结果。结论/影响 药剂师可以很好地实施 ACB 减少干预。这是对减少老年人 ACB 干预措施的第一次系统评价，它强调了在社区和特定患者人群中开发和测试高质量的实用临床和成本效益试验的必要性，这些试验面临 ACB 危害的高风险。[PROSPERO 注册：CRD42018089764]。4 个 RCT 中的两个和所有非 RCT 报告干预后 ACB 下降。没有研究报告成本结果。结论/影响 药剂师可以很好地实施 ACB 减少干预。这是对减少老年人 ACB 干预措施的第一次系统评价，它强调了在社区和特定患者人群中开发和测试高质量的实用临床和成本效益试验的必要性，这些试验面临 ACB 危害的高风险。[PROSPERO 注册：CRD42018089764]。它强调了在社区和特定患者人群中开发和测试高质量的实用临床和成本效益试验的必要性，这些试验具有 ACB 危害的高风险。[PROSPERO 注册：CRD42018089764]。它强调了在社区和特定患者人群中开发和测试高质量的实用临床和成本效益试验的必要性，这些试验具有 ACB 危害的高风险。[PROSPERO 注册：CRD42018089764]。