Anticholinergic Burden in Older Patients: A Survey to Investigate Knowledge, Attitudes, and Practices Among Physicians in Taiwan

Background and Objectives: Anticholinergic burden (ACB) cumulatively leads to adverse outcomes and increased mortality. Taiwan's NHIRD prevalence studies indicate ~60% of elderly patients (≥65) annually receive anticholinergic medications. In those with polypharmacy, 60–80% were exposed to anticholinergic medications, which was linked to higher risks of pneumonia, myocardial infarction, and stroke. This study aims to survey physicians’ knowledge and attitudes on Anticholinergic Burden (ACB) in Taiwan, directly addressing a recognized gap in clinical practice. Materials and Methods: This nationwide, anonymized online 3-month survey (July–September 2025), used the KAP framework. Physicians from 92 hospitals across Taiwan were invited to participate via e-mail. The survey covered demographics, ACB knowledge, attitudes, practices, and feedback, utilizing branching logic. Data was analyzed and presented descriptively. Of 62 respondents, only 23% of physicians were aware of the term 'Anticholinergic Burden' (ACB). Knowledge of specific common medication ACB scores was low (average 1.86/10), and respondents showed significant uncertainty regarding the risks associated with high ACB. Despite 53% of physicians (33/62) rating ACB assessment as "Important/Very Important," this rarely translated into practice: most never calculated scores, and only one did so routinely. Fifty-six participants' overwhelming demand for increased ACB education emphasizes the critical need for training to close both the identified knowledge and knowledge-practice gaps. Conclusions: Physician’s knowledge of medicines with anticholinergic property is relatively low in Taiwan despite the awareness of its importance. There is a clear knowledge and knowledge-practice gap which can be addressed through targeted educational activities.