BACKGROUND: Anticholinergic medication use is increasing, particularly among older adults due to polypharmacy and comorbidities. High anticholinergic burden is linked to adverse outcomes such as reduced mobility and increased dementia risk. Acute hospital stays may offer an opportunity to address this often-overlooked issue. AIMS: To examine the effects of deprescribing anticholinergic medications on outcomes in older hospitalised patients. METHODS: Medline, Web of Science, Cochrane Library and Embase were searched from inception to September 2024. Studies included hospital-based deprescribing or medication review interventions targeting anticholinergic burden in patients aged ≥ 65 years. Narrative synthesis followed SWiM guidelines, with quality assessment using JBI Checklists. RESULTS: From 2042 records, eight studies met inclusion criteria. Designs included cohort (n = 4) and pre-post quasi-experimental (n = 4), with follow-up durations of up to 3 months. All reported medication-related outcomes; four assessed acceptability, one included clinical outcomes, and none examined safety. Six studies reported reductions in anticholinergic burden scores; three showed significant decreases in the proportion of patients prescribed anticholinergics, and two noted fewer potentially inappropriate medications. Most recommended changes were implemented. CONCLUSION: Deprescribing interventions in hospital appear acceptable and effective in reducing anticholinergic burden. However, evidence on clinical outcomes, costs and safety is limited. Further RCTs with longer follow-up are needed.