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Researchers developed the Anticholinergic Medication Index to help clinicians identify older people whose combined medicines may be associated with falls or delirium. Its clinical decision-support version is already live in two NHS trusts, while pilots in hospital wards are examining whether it can be used more widely; evidence that the tool itself reduces these outcomes has not yet been reported.
Researchers have developed a medication-risk tool designed to help NHS clinicians identify people aged 65 and older whose combined use of anticholinergic medicines may put them at increased risk of falls or delirium. Its clinical decision-support version is live in two NHS trusts, but the research report does not establish that using it has reduced either outcome.
The Anticholinergic Medication Index, or ACMI, scores a patient’s anticholinergic medication burden using predicted risks of delirium or falls. The tool is designed to work within electronic patient records, showing clinicians the medicines contributing to a score and helping them prioritize patients for a structured medication review.
Researchers piloted the index in Bradford GP practices, where it automatically produced lists of patients aged 65 and older, their scores, contributing medicines and predicted one-year risk of a fall or delirium. The report says this information would otherwise have had to be calculated patient by patient before pharmacists could identify people for review.
A related clinical decision-support system, called ACMICS, has been embedded in hospital records at two NHS trusts and is in use. It recalculates when an anticholinergic medicine is started or stopped and appears at points in the clinical workflow. The team has also produced a technical specification intended to help other organizations build an equivalent system in their own records.
Earlier Reviews of Risky Prescriptions
The tool addresses a practical problem in medication review: a drug may have anticholinergic effects even when that is not its main purpose, and a patient taking several such medicines can accumulate a higher burden. Automated calculation could help clinicians find patients who might otherwise require time-consuming, individual checks, and direct attention to the medicines behind the score.
The researchers say anticholinergic medicines are widely prescribed. First author Dr. Kate Best said around 50% of older adults in the UK are prescribed at least one such medicine each year. She said a medicine may sometimes be the best treatment, while the combined burden can pose a risk. The index is intended to support a review, not automatically direct clinicians to stop treatment.
Falls and delirium can have serious consequences for older people and place demands on health services. The work’s significance is currently its potential to make risk assessment more practical within routine care. Whether wider use leads to fewer falls or delirium cases, or improves other patient outcomes, remains to be established.
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From Risk Model to NHS Records
The study, published in BMJ Medicine, is titled “Deriving the anticholinergic medication index for delirium and falls in older people: development and external validation of a risk prediction model.” Researchers from the University of Leeds, University of Liverpool and Bradford Institute for Health Research developed and tested the index using health data from nearly 750,000 adults over 65.
For development, the team used de-identified linked primary- and secondary-care records from Connected West Yorkshire. The researchers then tested the index using a national dataset of patients in Wales held by the SAIL Databank. The report describes this as external validation of the prediction model; it is separate from evidence that implementation of the tool changes patient outcomes.
The team has also studied how to embed ACMI in hospital electronic records. Researchers said ACMICS was designed around observed clinical workflows and can recalculate as prescriptions change. The tool’s current use in two trusts shows it has moved beyond a standalone research calculator, though the source does not give details of those trusts or the duration and scale of use.
““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
Patient Outcomes Still Need Testing
The source reports development, external validation and implementation, but does not report a measured reduction in falls, delirium or dementia attributable to ACMI or ACMICS. The tool estimates risk; it does not establish that a particular medicine caused an individual patient’s symptoms or that changing a prescription will prevent an event.
Details are also not provided on the number of patients assessed during the Bradford or hospital pilots, how often clinicians acted on scores, or the effects on medication changes and patient safety. The researchers are piloting ACMI in several geriatric medicine and hip-fracture wards to examine whether wider use in hospital care is feasible. Results from those pilots are not included in the report.
Hospital Pilots to Test Wider Use
The research team says it is continuing pilots in geriatric medicine and orthopedic hip-fracture wards to assess the feasibility of broader secondary-care rollout. The technical specification may also help other health organizations develop a version integrated with their own electronic records.
Readers can expect the next useful evidence to address how the system performs in routine care: whether staff use its alerts, whether medication reviews follow, and whether those reviews affect prescribing and patient outcomes. The source gives no publication date for pilot findings or timetable for national rollout, so broader NHS availability remains uncertain.
Key Questions
What is the Anticholinergic Medication Index?
The ACMI is a score designed to estimate older patients’ anticholinergic medication burden in relation to predicted risks of delirium or falls. It identifies the medicines contributing to the score to support a clinician-led review.
Is the tool already being used by the NHS?
Its clinical decision-support version, ACMICS, is reported to be live and in use in electronic records at two NHS trusts. Further pilots are under way in hospital wards, but the report does not describe a national rollout.
Has the tool been shown to prevent falls or delirium?
The source describes a developed and externally validated risk model and reports that its decision-support version has been implemented. It does not report evidence that the tool itself has reduced falls or delirium.
Does a high score mean a patient should stop a medicine?
No. The score is intended to help prioritize a structured medication review. The report says some anticholinergic medicines may be the best treatment in particular cases; any prescription decision requires clinical assessment.
Source: medicalxpress.com
