Pharmacist-Driven Deprescribing to Reduce Anticholinergic Burden in Veterans With Dementia

The American Geriatrics Society Beers Criteria strongly recommends avoiding anticholinergic medications in patients with dementia or cognitive impairment due to the risk of adverse central nervous system effects. In the veteran population, about 35% of patients with dementia are prescribed a medication regimen with a high anticholinergic burden. This article examines the role of pharmacists for reducing anticholinergic burden in veterans with dementia.

Outpatients with dementia or cognitive impairment at the Veterans Affairs Louisville Healthcare System who were prescribed a potentially inappropriate anticholinergic medication as classified by the Beers Criteria were selected using the VIONE (Vital, Important, Optional, Not needed, Every medication has an indication) deprescribing dashboard. Electronic health record medication reviews were completed by a pharmacist. The prescriber and patient's primary care practitioner were advised to perform patient-specific risk-benefit assessments, deprescribe potentially inappropriate anticholinergic medications, and consider safer alternative medications based on the indication.

This quality improvement project suggests that with the use of population health management tools and in collaboration with the interdisciplinary team, pharmacists can identify and deprescribe inappropriate anticholinergic medications. Pharmacists can provide evidence-based recommendations to guide risk-benefit discussion and consider safer nonanticholinergic alternatives (both pharmacologic and nonpharmacologic), aiding in anticholinergic deprescribing.