TL;DR
Get health and wellness essentials delivered free with Prime
- Fast, free delivery on millions of items
- Prime Video, Amazon Music and more included
- Member-only deals all year
Researchers have developed the Anticholinergic Medication Index (ACMI), a tool that scores older adults’ exposure to medicines with anticholinergic effects and estimates their one-year risk of falls or delirium. It has been piloted in Bradford GP surgeries and an electronic decision-support version is in use at two NHS hospital trusts; the researchers are testing its use in additional hospital wards.
Researchers have developed a tool to help clinicians identify adults aged 65 and older whose use of medicines with anticholinergic effects may put them at higher risk of delirium or falls. The Anticholinergic Medication Index (ACMI) was developed and tested using health records for nearly 750,000 adults and has been piloted in primary care, as well as embedded in hospital electronic records at two NHS trusts.
The ACMI calculates a score based on a patient’s anticholinergic medication burden, with the index designed around risks of delirium and falls. In the Bradford GP surgery pilot, it automatically produced lists of patients aged 65 and older, their scores, the medicines contributing to them and their predicted risk over one year. This information could otherwise require clinicians or pharmacists to review records individually before deciding whom to prioritise for a structured medication review.
The researchers developed the index using de-identified, routinely collected healthcare records from Connected West Yorkshire and tested it with a national dataset from Wales held in the Secure Anonymised Information Linkage (SAIL) Databank. The findings were published in BMJ Medicine. The report describes the work as a prediction and prioritisation tool; it does not establish that using ACMI itself reduces falls or delirium.
A clinical decision-support version, called the Anticholinergic Medication Index Clinical Decision Support System (ACMICS), is live in two NHS hospital trusts, according to the research team. It is built into electronic patient record systems and recalculates when an anticholinergic medicine is started or stopped. Researchers are also piloting the tool in geriatric medicine and orthopaedic hip fracture wards to assess whether it can be used more widely in hospitals.
How the Tool Could Guide Reviews
The tool addresses a practical problem in prescribing: anticholinergic effects are associated with many medicines, including drugs prescribed for purposes other than treating a condition through that effect. A patient taking several such medicines can accumulate what clinicians call anticholinergic burden. A score generated from existing records could help pharmacists and doctors identify people for whom a closer review may be useful, rather than relying on manual searches of every patient’s prescriptions.
The potential reach is substantial in UK primary care: the source report says about half of older adults are prescribed at least one anticholinergic medicine each year. That figure refers to annual prescribing in the UK, not the proportion who experience harm. Medicines may still be appropriate for individual patients, and the tool is intended to support clinical review, not to make treatment decisions on its own. Researchers say falls and delirium can have serious effects on older people’s health and wellbeing, as well as costs for the NHS.
Products Worth Considering
Oura Ring 5 Smart Ring – Stealth, Size 11
BowFlex Results Series SelectTech Adjustable Dumbbells (Pair)
Fitbit Inspire 3 Health and Fitness Tracker Bundle
As an affiliate, we earn on qualifying purchases.
From Risk Scores to Patient Records
Anticholinergic medicines are used for a range of conditions, and some medicines have anticholinergic effects even when that is not their main purpose. The concern addressed by ACMI is the combined burden across a person’s medicines. The report also links anticholinergic burden with dementia and other side effects, including constipation, difficulty emptying the bladder and dry mouth; the new tool’s described risk estimates focus on falls and delirium.
The work was led by researchers from the University of Leeds, University of Liverpool and Bradford Institute for Health Research, with funding from Health Data Research UK. The ACMI was designed to work within electronic patient record systems instead of requiring clinicians to use a separate online calculator. Its developers say an accompanying technical specification is available to help other organisations build an equivalent system in their own records platforms.
“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 the Pilots Have Not Established
The report does not provide evidence that ACMI-led reviews have already reduced the number of falls, delirium cases or hospital admissions. It also does not specify how many patients were included in the Bradford pilot, how frequently the tool flagged patients, or what proportion of flagged patients subsequently had their medicines changed. A predicted risk is not a guarantee that an event will occur.
Wider use will depend on further evaluation and on how the index performs across different patient populations and electronic record systems. The researchers are examining feasibility in additional hospital wards, but the source does not give a timetable for completing those pilots or a date for broader NHS deployment.
Testing Use Across Hospital Wards
The research team says it is piloting ACMI in several geriatric medicine and orthopaedic hip fracture wards to assess the feasibility of expanding use in secondary care. The next evidence to watch for includes results on how the tool fits into clinical workflows, how often it prompts medication reviews and whether those reviews affect patient outcomes. The researchers have also produced a technical specification that other organisations can use when developing an equivalent system for their electronic records.
Key Questions
What does the Anticholinergic Medication Index do?
The ACMI scores a patient’s anticholinergic medication burden and is designed to help clinicians identify older adults who may need a review. The pilot version also displayed medicines contributing to the score and estimated one-year risks of falls or delirium.
Does a high ACMI score mean someone will have a fall or delirium?
No. The score is intended to support prioritisation and estimate risk; it does not predict with certainty that an individual will experience either outcome. Decisions about medicines remain for patients and qualified healthcare professionals to discuss.
Where is the tool being used?
The ACMI was piloted at GP surgeries in Bradford. Its electronic decision-support version is reported to be live in two NHS hospital trusts, and further pilots are underway in geriatric medicine and orthopaedic hip fracture wards.
Has the tool been shown to prevent falls or delirium?
The source report describes development, testing and implementation, but does not report evidence that ACMI use has reduced falls or delirium. Its current stated purpose is to help identify patients for medication review.
Source: news-medical.net
