Identifying Predictors and Measuring Variation in Anticholinergic Burden and Sedative Load for Older Adult Care Home...

There over 250,000 care home residents in England and they account for a disproportionate number of hospital admissions. Since 2020, structured medication reviews for care home residents have been mandated in primary care contracts. We used a nationally representative cohort of care home residents to identify predictors of anticholinergic burden and sedative load and measure regional variation in prescribing.

Using primary care data from a third of practices in England we derived four 6-month cohorts of over 40,000 care home residents linked to the national regulator's register of care homes between 01/01/2023 and 31/12/2024. We estimated three-level logistic regression models including resident, postcode district and commissioner (ICB) level factors which predicted high anticholinergic burden and sedative load. We estimated funnel-plots to measure case-mix risk adjusted variation in prescribing at postcode district and commissioner geographical levels.

Significant predictors of anticholinergic burden and sedative load included gender, age, frailty, and comorbidity. We demonstrated some case-mix adjusted variation at ICB and postcode district level (anticholinergic burden 2.3-fold ICB and 3.5-fold variation at district level; sedative load 1.7-fold ICB and 2.7-fold variation at District level).

This is one of the largest studies of care home residents in England. We have identified factors associated with risk of residents having a high anticholinergic burden or sedative load which could be used to help target personalised interventions.