Predictors and prescribing patterns of definite anticholinergic medication use among community-dwelling older adults in Saudi Arabia: a retrospective multicenter cross-sectional study

Background/objectivesAnticholinergic 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.MethodsThis 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.ResultsThe 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).ConclusionsDefinite 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.