\received DD MMMM YYYY \acceptedDD MMMM YYYY Aim: Both anticholinergic burden (ACB) and depression are known to increase fall risk in older persons, next to increasing morbidity and mortality. However, the effect of depression on fall risk associated with ACB is unclear. This is relevant because most antidepressants have anticholinergic effects. The aim of this study was to assess the relationship between ACB and falls, and the impact of depression on this relationship. Methods: We cross-sectionally examined the relationship between both ACB and clinical depression and falls in the past 12 months, in a harmonized cohort of Dutch community dwelling persons (n=7884). For all analyses, we calculated adjusted odds ratios (ORs) and their 95% confidence intervals. We also investigated the impact of depression on the relationship between ACB and falls, by calculating interaction on both an additive and multiplicative scale. Results: Both a high ACB score (≥3) and clinical depression were independently significantly associated with falls in the past 12 months. Additionally, there was a statistically significant interaction (p=0.038) between ACB and clinical depression on fall risk, both on an additive and multiplicative scale (1.13 and 1.44 respectively). Conclusion: In older persons, the presence of clinical depression strengthened the association between ACB and falls. We dissuade bluntly withholding pharmacological treatment to avoid falls, despite the ACB of antidepressants. In case of depression, we recommend considering non-pharmacological alternatives; choose pharmacological interventions with the lowest risk of adverse events; assess and treat other fall risk-factors; and perform multidisciplinary a medication review to minimize (accumulation of) ACB.

Rationale, aims and objectives: Colour-coded wristbands (CCWs) are widely used to signal special patient status to health care professionals. However, little is known about the feasibility of CCWs. The current study describes a process evaluation of an intervention in which CCWs were used to signal special patient status to health care professionals on the neurology Ward of a university hospital in the Netherlands. In this intervention, CCWs were issued to patients with an increased risk of falling and patients with dysphagia. Methods: Quantitative and qualitative methods were used to evaluate the reach of the intervention, performance according to protocol, compliance to the intervention, staff’s opinion on the intervention, and contextual factors that may have affected the implementation of the intervention. Data were gathered by means a self-administered questionnaire among the care professionals on the neurology ward and by means of a semi-structured interview among a subgroup of care professionals who guided the implementation process on the ward. Results: Five care professionals were interviewed and 23 care professionals (57.5%) responded to the questionnaire. Most professionals indicated they had received information about the CCWs and their role in conducting the intervention. The intervention was largely performed according to protocol, however some deviations from protocol were reported with respect to how family members were informed of the intervention, how the CCWs were issued, and how often patients were inspected for having the appropriate CCWs. Overall, staff members evaluated the intervention positively and perceived patients to be content with the CCWs. Conclusion: We conclude that the CCWs were largely implemented according to protocol. Our findings highlight some challenges that can arise when implementing CCWs. Recommendations are made to optimize the feasibility of the intervention.