Drugs with anticholinergic properties identified by the ACB scale and ARS are associated with worse cognitive and functional performance in elderly patients. The ACB scale might permit a rapid identification of drugs potentially associated with cognitive impairment in a dose-response pattern, but the ARS is better at rating activities of daily living.

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Hospitalization was associated with an increase in potentially severe DDIs. A significant association was found for mortality at 3 months after discharge in patients with at least two potentially severe DDIs. Careful monitoring for potentially severe DDIs, especially those created at discharge or recently generated, is important to minimize the risk of harm.

AIMSThe aim of the study was to evaluate the effect of an e-learning educational program meant to foster the quality of drug prescription in hospitalized elderly patients. METHODSTwenty geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control (basic geriatric pharmacology notions). Logistic regression analysis was used in order to assess the effect of the intervention on the use of potentially inappropriate medication (PIM, primary outcome) at hospital discharge. Secondary outcomes were a reduced prevalence of at least one potential drug-drug interaction (DDI) and potentially severe DDI at discharge. Mortality rate and incidence of re-hospitalizations were other secondary outcomes assessed at the 12-month follow-up. RESULTSA total of 697 patients (347 in the intervention and 350 in the control arms) were enrolled. No difference in the prevalence of PIM at discharge was found between arms (OR 1.29 95%CI 0.87-1.91). We also found no decrease in the prevalence of DDI (OR 0.67 95%CI 0.34-1.28) and potentially severe DDI ) at discharge, nor in mortality rates and incidence of rehospitalization at 12-month follow-up. CONCLUSIONSThis e-learning educational program had no clear effect on the quality of drug prescription and clinical outcomes in hospitalized elderly patients. Given the high prevalence of PIMs and potential DDIs recorded in the frame of this study, other approaches should be developed in order to improve the quality of drug prescription in this population. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Older people usually have multiple chronic diseases, so that they are often exposed to chronic polypharmacy and to a high risk of prescription of potentially inappropriate medications and drug-drug interactions.• E-learning is a educational technology with several advantages, never used before for improvement of drug prescription in hospitalized older people. WHAT THIS STUDY ADDS• This e-learning educational program failed to improve the quality of drug prescription in older patients acutely hospitalized in internal medicine and geriatrics wards.• But this randomized-controlled study confirms the high prevalence of PIM, DDI and severe DDI in hospitalized older people and confirms that drug-related problems and drug-drug interactions are often underestimated issues among clinicians. IntroductionIn Western countries, people aged 75 years or older are the fastest growing segment of the population, and will account for more than 20% of the total population by 2060 [1]. This group is characterized by the occurrence of multiple chronic diseases, almost always accompanied by the use of multiple drugs (polypharmacy) [1][2][3]. Polypharmacy has been associated with negative outcomes, including adverse drug reactions (ADRs) and increased risks of morbidity, mortality and multiple hospital admissions [2,4]. Older people are usually frail and more susceptible to ADRs owing to changes in pharmacokinetics and pharmacodynamics [5...