Deprescribe Multiple Anticholinergics in Older Populations

New Medicare measure targets multiple anticholinergic use in seniors.

2 minute read

As a clinical pharmacist, expect increased focus on limiting anticholinergic medications in older adults, driven by a new Medicare Star Ratings quality measure.

We know anticholinergics are on the Beers Criteria of potentially harmful drugs in patients 65 years and older due to the risk of cognitive impairment, falls, etc. They’re also associated with dementia.

Table (1)

Anticholinergic-Medications.

NPS-adv

The 2027 Medicare Star Ratings will assess health plans based on the use of multiple anticholinergic medications in older adults. However, this quality measure is already relevant now—because performance ratings are based on data collected two years earlier.

Be prepared for outreach from insurers or pharmacists if a patient aged 65 or older is taking two or more different anticholinergic meds for at least 30 consecutive days.
Evaluate each patient individually and determine whether these medications can be stopped or substituted with safer alternatives.
When deprescribing, generally stop or switch one anticholinergic medication at a time.

Taper if needed to reduce withdrawal or rebound effects.
Reassure patients that discontinuing a medication doesn't have to be a permanent decision.

If anticholinergics are necessary, prescribe the lowest effective dose and limit duration. Monitor closely for adverse effects and reassess the medication’s benefits and risks regularly.

NPS-adv

References

Centers for Medicare & Medicaid Services. Advance Notice of Methodological Changes for Calendar Year (CY) 2026 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. January 10, 2025. https://www.cms.gov/files/document/2026-advance-notice.pdf.
By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.
Pharmacy Quality Alliance. Measures Overview. Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (POLY-ACH). https://www.pqaalliance.org/measures-overview.

This note has been edited and reviewed by the pharmacy doctors on NPS team.