New research published in the Journal of the American Geriatrics Society suggests anticholinergic medication use in long-term care may be more common than previously recognized. By analyzing medications that were actually administered to residents—not simply prescribed—researchers gained a more complete picture of medication exposure and identified new opportunities to support safer prescribing decisions.

One in Three Residents Received Anticholinergic Medications

Researchers analyzed medication administration records from more than 45,000 long-stay residents in Veterans Affairs Community Living Centers and found that approximately one in three received at least one anticholinergic medication. Exposure remained common among residents living with dementia, despite these medications being associated with increased risks of cognitive impairment, delirium, and falls in older adults.

The study also found that first-generation antihistamines—many of which are available over the counter—were used more frequently than previous claims-based studies have suggested. Because these medications are often not captured in prescription claims, the findings indicate that anticholinergic exposure in long-term care may be underestimated.

Supporting Smarter Medication Reviews

The findings reinforce the importance of ongoing medication reviews in long-term care. While some anticholinergic medications remain clinically appropriate and necessary, the researchers identified opportunities to reduce unnecessary exposure, particularly when safer alternatives may be available.

Rather than recommending broad deprescribing initiatives, the study supports an individualized approach that considers each resident’s diagnosis, treatment goals, duration of therapy, and overall medication burden. Consultant pharmacists play an important role in identifying potentially unnecessary anticholinergic medications, evaluating safer alternatives when appropriate, and collaborating with prescribers and care teams to optimize therapy while continuing to manage complex clinical conditions effectively.

A Continued Focus on Medication Safety

The study also found that anticholinergic use declined modestly over time, suggesting growing awareness of medication-related risks. However, the continued prevalence of these medications highlights that medication optimization remains an important priority in long-term care.

As resident acuity continues to increase, thoughtful medication stewardship remains an essential part of delivering high-quality care. Studies like this reinforce the value of regular medication reviews and collaboration among pharmacists, prescribers, and care teams to help reduce unnecessary medication burden while supporting the best possible outcomes for older adults.