UK develops index for medication-related falls and delirium risk — News-Medical
In the United Kingdom, researchers have developed the ACMI anticholinergic medication index, intended to help doctors and pharmacists identify patients aged 65 and over who face an increased risk of delirium and falls. As News-Medical reports, the tool was created by scientists from the University of Leeds, the University of Liverpool and the Bradford Institute for Health Research, with funding from Health Data Research UK.
Assessing the cumulative effect of medications
Anticholinergic medications are used to treat various conditions, but this effect may also be produced by medicines for which it is not the primary effect. Taking several such medicines at the same time creates an anticholinergic burden. According to the researchers, it is associated with a higher risk of delirium, falls and dementia, especially among older people.
ACMI calculates this burden while taking into account the risk of delirium or a fall. It was developed for integration into electronic medical records so that healthcare professionals can more quickly identify patients with high scores and prioritize reviews of prescribed medications.
In the United Kingdom, at least one anticholinergic medication is prescribed annually to approximately 50% of older people. At the same time, the authors emphasize that in some cases such medicines may be the optimal treatment method.
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Trials in Bradford and hospitals
The team piloted ACMI in general practitioner practices in Bradford. The system automatically generated a list of patients aged 65 and over, including their ACMI score, the list of medications that contributed to it, and their predicted one-year risk of a fall or delirium. Without such a tool, pharmacists would have had to calculate this information separately for each person.
The index was developed and validated using anonymized medical data from nearly 750,000 people aged over 65. For this purpose, linked primary and secondary healthcare data from West Yorkshire were used, after which the model was tested on a large national database of patients in Wales.
The ACMICS clinical decision support system, based on the index, is already operating in two UK National Health Service trusts. It automatically recalculates the score when an anticholinergic medication is prescribed or discontinued. Researchers are also testing ACMI in geriatric and orthopedic wards for patients with hip fractures.
