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Background and Importance Anticholinergic burden (AB) is a predictor of cognitive and physical impairment, particularly in elderly populations, and it has been associated with an increased risk of falls, cognitive decline, and higher mortality rates. Although there is substantial evidence of the negative impact of high AB in elderly and complex chronic patients (CCP) in primary care, there are few studies specifically examining AB in intermediate care hospitals (ICH).Aim and Objectives To assess the AB risk in the treatment of CCP aged ≥65 years admitted to an ICH and to underscore the role of the hospital pharmacist as a key member of the multidisciplinary team.Material and Methods A descriptive cross-sectional study was conducted in a 99-bed ICH.Inclusion criteria were: patients aged ≥65 years and classified as CCP (defined as having multiple chronic conditions with frequent decompensations and a high risk of functional decline).The following information was collected from the electronic health record: active treatment, age and sex.AB was assessed using the following validated scales: Serum Anticholinergic Activity (CHEW), Anticholinergic Drug Scale (ADS), and Drug Burden Index (DBI).Results 80 patients met the inclusion criteria, with a mean age of 84 years (±7.7); 60.8% were female. Globally, 173 different active substances were identified, of which 58 (33.5%) had anticholinergic properties.The mean number of prescriptions per patient was 14 (±4), being 5 (±2) anticholinergic drugs.The most frequently prescribed anticholinergic drugs were: quetiapine (20.3%), furosemide (12.2%), metformin (4%), sertraline (2.7%), and prednisone (2.7%). The active substances with the highest AB included: cetirizine, clomipramine, clonazepam, citalopram, digoxin, famotidine, fentanyl, hydroxyzine, mirtazapine, prednisone, quetiapine.Anticholinergic risk varied depending on the scale used. The proportion of patients with moderate-high risk was 35% according to the CHEW scale, 72.6% with the ADS scale, and 86.3% with the DBI scale.Conclusion and Relevance Anticholinergic risk in CCP aged ≥65 years admitted to an ICH is high. The level of risk varies depending on the scale used. However, one-third of patients showed moderate-high risk, even exceeding 70% according to the ADS and DBI scales. These findings support the inclusion of hospital pharmacists in the multidisciplinary team to optimise pharmacotherapy, reduce adverse events, and improve patient safety.Conflict of Interest No conflict of interest