Managing medication safety in older adults is critical, especially when it comes to the use of multiple anticholinergic drugs. The 2025 Medicare Star Ratings include a measure that tracks concurrent use of these medications among members aged 65 and older—a key factor in improving care quality and reducing risks like cognitive decline and sedation.
A STAR measure is part of the Medicare Star Ratings system from CMS, used to evaluate the quality and performance of Medicare Advantage (Part C) and Part D (prescription drug) plans. These measures help beneficiaries compare plans and push insurers to improve care.
In 2025, there is a STAR measure that quantifies the percentage of elderly members (65 and older) with concurrent use of ≥2 unique anticholinergic (ACH) medications for at least a 30-day supply on different dates of service during the measurement year. Members in hospice are excluded. Please consider the risks and benefits when prescribing anticholinergic medications.
Examples of Anticholinergic Medications: Antihistamines, muscle relaxants, antiemetics, antimuscarinics, antispasmodics, antipsychotics, antiarrhythmics, and antiparkinsonian agents.
Tips for Prescribers:
- Consider risks and benefits, non-drug therapies, or different medications prior to prescribing multiple anticholinergic medications to elderly members
- Educate members about risks of concurrent anticholinergic medications and monitoring for side effects such as cognitive decline, confusion, dry mouth, blurry vision, urinary retention, or excess sedation
- Assess and document medication usage on a regular basis
- Deprescribe when appropriate
Resources:
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American Geriatrics Society. 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71:2052–2081.
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Pharmacy Quality Alliance (PQA) website. Accessed May 22, 2025.
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López-Álvarez J, Sevilla-Llewellyn-Jones J, Aguera-Ortiz L. Anticholinergic drugs in geriatric psychopharmacology. Front Neurosci. 2019;13:1309.
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Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergic medications and incident dementia. JAMA Intern Med. 2015;175(3):401–407.
