Purpose: Falls among hospitalized patients significantly reduce their quality of life and increase healthcare costs. Anticholinergic drugs are recognized as key risk factors for falls. This study analyzed the relationship between falls and the Japanese Anticholinergic Risk Scale scores to provide clinical evidence.

Methods: Patients admitted between January 2022 and December 2023 were classified into fall and non-fall groups. Propensity score matching was adjusted for age, sex, body mass index, activities of daily living and disease. Fall risk was analyzed based on the Japanese Anticholinergic Risk Scale scores; low (1-2 points), moderate (3-4 points), and high (≥ 5 points). Logistic regression analysis was used to determine the odds ratios, and sensitivity and specificity were evaluated.

Results: Among the 19,739 patients, 310 matched cases were analyzed. Two scores of one point showed an odds ratio of 2.38 (p＝0.020). Risk increased in the low- (odds ratio; 1.71, p＝0.035) and moderate-risk groups (odds ratio; 2.18, p＝0.030), but stabilized in the high-risk group (odds ratio; 2.14, p＝0.170). Sensitivity was highest at four points (92%); however, specificity was low.

Conclusion: The Japanese Anticholinergic Risk Scale effectively predicted fall risk, especially moderate risk. However, fall risk did not increase proportionally with higher scores, suggesting that other factors influenced the outcomes. Comprehensive assessment of patient comorbidities is essential for effective fall prevention.

Information on urinary disorders associated with the use of over-the-counter (OTC) drugs is limited, and evaluations using the Anticholinergic Risk Scale have not progressed significantly. Therefore, we investigated the patients with urinary disorders associated with the use of OTC drugs included in the Japanese Adverse Drug Event Report (JADER) database using an anticholinergic risk scale. The survey items included patient background, year reported, generic and brand drug names, and components of the OTC drug. The total anticholinergic burden was calculated using the Japanese Anticholinergic Risk Scale. Sixty-six patients with urinary disorders associated with the use of OTC drugs were identified in the JADER database, which covered the period from April 2004 to March 2024. Most cases have been reported in men and the elderly, and approximately 35% of the patients had already experienced urinary problems at the time of OTC drug use. The most frequently reported suspected drugs were a combination cold remedies, followed by Kampo medicines, and medicines for otolaryngological problems. The most common formulations contained chlorpheniramine (including d-chlorpheniramine) and codeine (including dihydrocodeine). The products with the highest total anticholinergic burden had a score of 6, including four medicines for otolaryngological problems. When using OTC drugs in elderly men, especially in those with urinary problems, it may be necessary to provide more information and monitor them for drug-induced urinary disorders.

Polypharmacy in the elderly is known to increase the risk of adverse drug events. Currently, the impact of operational improvements according to polypharmacy-related guidelines is unknown. Additionally, many patients were not treated by the polypharmacy task force at our hospital. We investigated the changes in the number of patients and prescription suggestions to evaluate the effect of operational improvements according to the polypharmacy-related guidelines, including changes in screening methods and task shifting/sharing with pharmacists in charge of hospital wards. As a result, the number of patients for whom prescription suggestions were made increased, and the number of prescription suggestions based on physical function assessments by multiple professions increased. The results suggest that the patients targeted for multidisciplinary patient assessment and prescription optimization activities can be expanded by improving the tasks related to screening based on physical function assessments and through strengthening collaboration with the pharmacists in charge of hospital wards.

This study evaluated the adverse events observed over a 6-month period in patients prescribed levodopa at the outpatient clinic of the Department of Neurology, Fukuoka University Hospital, as of January 2023. The incidence of adverse events was 15.9% (58/364 patients), with hallucinations (n＝13), dyskinesia (n＝13), and dizziness/instability (n＝8) being the most common. A multivariate analysis identified that the addition or dose escalation of anti-parkinsonian drugs (P＜0.001) and a disease duration of≥6 years (P＝0.038) were significantly associated with adverse events. Additionally, evaluation using the Naranjo Adverse Drug Reaction Probability Scale showed that only 39.7% (27/68 drugs) of cases were judged to have a strong relationship between the drug and adverse events. These findings underscore the importance of adverse event monitoring, particularly during the addition or dose escalation of anti-parkinsonian drugs, for patients in advanced stages of parkinsonism who are treated with levodopa.

Objective: We developed an integrated checklist for frailty, malnutrition, and sarcopenia in the elderly in our community, and aimed to train pharmacy pharmacists how to detect and support early detection using the checklist.

Methods: A checklist was developed based on the Simple Frail Index, MNA^®-SF, AWGS2019, and the finger ring test. Pharmacy pharmacists were trained to conduct surveys on community events.

Results: The survey using the integrated checklist showed that 8.9% of all participants were frail, 55.9% were pre-frail, 27.9% were at risk of malnutrition, 5.0-17.9% had suspected sarcopenia, and 43.0-48.6% had confirmed sarcopenia, which was close to the previously reported results and confirmed the validity of this initiative. Frailty is significantly associated with pre-frailty, age, and malnutrition.

Discussion: We believe that the use of this tool by pharmacists in pharmacies and community event booths will facilitate the efficient and effective health support for elderly individuals in the community.