Identifying Predictors and Measuring Variation in Anticholinergic Burden and Sedative Load for Older Adult Care Home Residents: A Retrospective Cohort Study Using Routinely Collected Data

Purpose

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. Patients and Methods: 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.