TL;DR
Get workout gear delivered free with Prime
- Fast, free delivery on millions of items
- Prime Video, Amazon Music and more included
- Member-only deals all year
Researchers developed the Anticholinergic Medication Index to help clinicians identify older patients whose combination of medicines may put them at higher risk of falls or delirium. Its clinical decision-support version is in use at two NHS trusts, while further pilots examine whether it can be rolled out more widely.
Researchers have developed and begun using an electronic-record tool to help NHS clinicians identify older patients whose medicines may raise their risk of falls or delirium. The Anticholinergic Medication Index (ACMI), developed by teams at the universities of Leeds and Liverpool and Bradford Institute for Health Research, was built and tested using health data from nearly 750,000 people aged over 65; its clinical decision-support version is live in two NHS trusts.
The ACMI scores a patient’s anticholinergic medication burden in relation to the risk of delirium or falls. Anticholinergic effects can come from medicines prescribed for different conditions, including drugs for which that effect is not the main purpose. When a person takes several such medicines, their combined burden can be a concern, particularly in older age.
In a pilot in Bradford general practices, the tool automatically generated lists of patients aged 65 and older, their scores, the medicines contributing to those scores and their predicted risk over one year of a fall or delirium. The research team said that without this automation, clinicians would need to calculate the information for individual patients before pharmacists could prioritize medication reviews.
A clinical decision-support version, called ACMICS, has been embedded in electronic patient record systems at two NHS trusts and is in use, according to the report. It recalculates scores when an anticholinergic medicine is prescribed or stopped. Researchers have also produced a technical specification that other organizations could use to develop an equivalent system in their own records.
Making Medication Reviews Easier to Target
The tool addresses a practical problem: older patients may be prescribed several medicines with anticholinergic effects, while working out the combined burden and deciding who needs review takes clinical time. By bringing the score into electronic records, ACMI could help clinicians and pharmacists identify patients for a structured medication review without first calculating every case manually.
The potential benefit is safer, more informed prescribing, not a guarantee that falls or delirium will be prevented. The research report says anticholinergic medicines can sometimes be the best treatment; a high score is intended to support clinical review, not automatically prompt stopping a medicine. Decisions need to account for a patient’s conditions and treatment needs.
First author Dr. Kate Best said about 50% of older adults in the UK are prescribed at least one anticholinergic medicine annually. That figure describes prescribing prevalence, not the proportion who will experience harm. The researchers say falls and delirium can have serious effects on older people’s health and wellbeing and impose costs on the NHS.
Products Worth Considering
Fitbit Sense 2 Health and Fitness Smartwatch, Shadow Grey/Graphite
Levoit Eleva 500X HEPA Air Purifier for Large Rooms
Levoit Core 400S-P Smart Air Purifier for Large Rooms
As an affiliate, we earn on qualifying purchases.
From Risk Data to NHS Records
The ACMI was derived using de-identified routine health records accessed through Connected West Yorkshire, which links primary and secondary care data. Researchers then tested the index against a large national dataset in Wales held by the Secure Anonymized Information Linkage Databank. The work is reported in the journal BMJ Medicine as a study on developing and externally validating a risk-prediction model.
The team has also examined use in hospital settings. The report says ACMI is being piloted in several geriatric medicine and hip-fracture wards to assess whether wider use in secondary care is feasible. The system’s embedded design is intended to fit existing electronic records and clinical workflows rather than require staff to use a separate online calculator.
“Approximately 50% of older adults are prescribed at least one anticholinergic medication annually in the U.K.”
— Dr. Kate Best, associate professor of applied statistics at the University of Leeds and the study’s first author
How Much Harm Can It Prevent?
The report does not establish that using ACMI has already reduced falls, delirium, hospital admissions or NHS costs. It describes development, validation and implementation, but gives no measured patient-outcome effect from the tool’s use. A risk score identifies predicted risk; it does not show that changing treatment will prevent an event.
Further details about how many patients have been assessed through the live systems, how often the tool leads to medication changes, and the outcomes of those changes are not provided in the supplied report. It also remains unclear how readily other NHS organizations can adopt the system across different electronic-record platforms.
Hospital Pilots Will Test Wider Use
Researchers are piloting ACMI in several geriatric medicine and orthopedic hip-fracture wards to assess the feasibility of a wider secondary-care rollout. The technical specification is intended to help other organizations build an equivalent tool into their own electronic records.
The next evidence needed is whether routine use changes medication-review practice and, in turn, patient outcomes. The report does not give a timetable for completing the ward pilots or a decision date for broader NHS deployment.
Key Questions
What does the Anticholinergic Medication Index do?
The ACMI scores a patient’s combined anticholinergic medication burden in relation to predicted risk of delirium or falls. Its electronic version can show the medicines contributing to the score and recalculate when a medicine is prescribed or stopped.
Is the tool already being used in the NHS?
Yes. The report says the ACMI clinical decision-support system is live and in use at two NHS trusts. Separate pilots are under way in hospital wards to assess the feasibility of wider use.
Does a high score mean a patient should stop a medicine?
No. The score is intended to help clinicians identify patients who may need a medication review. The report notes that an anticholinergic medicine may sometimes be the best treatment; decisions about changing medicines require clinical judgment.
Has ACMI been shown to prevent falls or delirium?
The supplied report describes how the tool was developed, tested and deployed, but does not report measured reductions in falls, delirium or related costs from using it. Those outcomes remain to be established.
Source: medicalxpress.com
