TL;DR
Turn quiet afternoons into listening time
- Thousands of audiobooks, podcasts and originals
- Listen on your phone, tablet or Echo — also offline
- Cancel anytime
Researchers have developed the Anticholinergic Medication Index to help identify older adults whose combined medication effects may raise their risk of delirium or falls. The tool was developed and tested using health records from nearly 750,000 people aged over 65 and has been embedded in electronic records at two NHS trusts; wider rollout is still being assessed.
Researchers have developed a tool to help clinicians identify older adults taking multiple anticholinergic medicines who may be at increased risk of delirium or falls. The Anticholinergic Medication Index (ACMI), described in BMJ Medicine, is designed to calculate medication burden from electronic health records and help healthcare teams prioritise patients for a medicines review.
The research team, from the University of Leeds, University of Liverpool and Bradford Institute for Health Research, developed the index using de-identified healthcare records for nearly 750,000 adults aged over 65. Researchers accessed linked primary and secondary care data through Connected West Yorkshire, then tested the index using a national dataset of patients in Wales held by the Secure Anonymised Information Linkage (SAIL) Databank.
In a pilot at GP surgeries in Bradford, the tool generated lists of patients aged 65 and over, including each person’s ACMI score, contributing medicines and predicted one-year risk of a fall or delirium. The report says that without automated scoring, staff would have had to calculate this information patient by patient before pharmacists could prioritise structured medication reviews.
A related clinical decision support system, called ACMICS, is already in use at two NHS hospital trusts, according to the report. It is embedded in electronic patient record systems and recalculates when an anticholinergic medicine is started or stopped. Researchers are also piloting the tool on geriatric medicine and orthopaedic hip-fracture wards to assess the feasibility of broader hospital use.
How Medication Scores Could Guide Reviews
The tool addresses a practical challenge in medicines safety: drugs with anticholinergic effects are used for different conditions, and that effect can be present even when it is not the medicine’s main purpose. When a person takes several such medicines, their combined burden may be difficult for a clinician to assess quickly across a long medication list. The researchers say an automated score in the patient record could help clinicians spot people who may need closer review.
The potential relevance is broad in the UK: the report says about half of older adults are prescribed at least one anticholinergic medicine each year. That figure refers to annual prescribing of at least one such medicine, not to the share experiencing an adverse outcome. The index is intended to support decisions about review, rather than automatically changing treatment. Some anticholinergic medicines may still be the most suitable option for an individual patient.
Falls and delirium can have serious consequences for older people and can require substantial healthcare support. Identifying possible medication-related risk earlier may give pharmacists and clinicians a way to examine whether a person’s medicines remain appropriate, while weighing potential harms against the reasons each drug was prescribed.
Products Worth Considering
Oura Ring 5 Smart Ring – Stealth, Size 11
LEVOIT Vital Pet Pro Smart Air Purifier
Fitbit Versa 2 Health and Fitness Smartwatch with Heart Rate, Alexa, Music, Sleep and Swim Tracking
As an affiliate, we earn on qualifying purchases.
From Risk Evidence to Clinical Records
Anticholinergic medicines are prescribed for a range of conditions. Their effects can also occur in medicines used for other purposes, so a patient may accumulate anticholinergic burden through several prescriptions rather than one obvious drug. The source report links higher burden with risks including delirium and falls; it also describes associations with dementia and side effects such as constipation, difficulty emptying the bladder and dry mouth.
Researchers say the ACMI was designed for integration into electronic patient record systems, instead of requiring clinicians to use a separate online calculator. Its development drew on linked health records in West Yorkshire, and its testing used data from Wales. The work was reported in the BMJ Medicine paper “Anticholinergic medication index: Advancing safer prescribing for older adults,” by P. S. Nishtala and G. Gill.
One of the researchers’ stated aims is to make the tool usable within routine clinical workflows. The team has produced a technical specification that other organisations can use to develop an equivalent system for their own electronic records, although local implementation would still require adaptation to those systems.
“For patients with multiple health conditions, it may be reassuring to know there is a tool that can flag when they might need a medication review.”
— Dr. Kate Best, first author and associate professor of applied statistics at the University of Leeds
What Wider Testing Must Establish
The available report does not give detailed performance measures for the ACMI, such as how accurately its scores predict delirium or falls, or how often a high score leads to a change in prescribing. It also does not report whether use of the tool has reduced falls, delirium, hospital admissions or other adverse outcomes. A predicted one-year risk is an estimate, not a guarantee that an event will occur.
The pilots show that the system can be used in certain care settings, but they do not establish that it will work equally well across all practices and hospitals. The report does not provide a timeline for wider adoption, identify which organisations will take it up next, or quantify the staffing and technical resources needed. Clinicians must also decide whether a medicine’s potential risks outweigh its benefits for each patient.
Hospital Pilots and Wider Rollout
The research team is piloting the ACMI in several geriatric medicine and orthopaedic hip-fracture wards to assess whether it can be used more widely in secondary care. The report does not state when those pilots will conclude or when results will be published. Their findings are expected to inform the feasibility of further deployment.
Other health organisations could use the team’s technical specification to build an equivalent system into their own electronic records. Wider use will depend on local implementation and on further evidence about how the scores perform in practice and whether medication reviews prompted by the tool improve patient outcomes.
Key Questions
What is the Anticholinergic Medication Index?
The ACMI is a scoring tool designed to estimate an older patient’s anticholinergic medication burden and help identify people who may need a medicines review. It is designed to work with electronic health records.
Which risks is the tool intended to flag?
The index is based on risk of delirium or falls. The report describes these as possible concerns associated with taking multiple medicines that have anticholinergic effects; a score does not mean that an individual will experience either outcome.
Has the tool been used in healthcare settings?
Yes. The report says ACMI was piloted at GP surgeries in Bradford, while a related system, ACMICS, is live at two NHS hospital trusts. Additional hospital-ward pilots are underway.
Does a high score mean a patient should stop a medicine?
No such instruction is reported. The tool is intended to help prioritise a clinical medication review. Decisions about starting, stopping or changing a medicine should be made by the patient and qualified healthcare professionals, taking the medicine’s benefits and risks into account.
Has the tool been shown to prevent falls or delirium?
The report describes development, testing and implementation pilots, but does not provide evidence that ACMI use has reduced falls or delirium. Its effect on patient outcomes remains to be established.
Source: news-medical.net
