An Investigation into the Association Between Anticholinergic Burden and Falls at Stable Steps Care Centre

Introduction

Falls are a major concern in the community due to their association with increased mortality. Anticholinergic medications are commonly prescribed in multimorbidity and are strongly associated with an increased risk of falls. This project aimed to determine whether anticholinergic burden (ACB) correlated with frequency or severity of falls and to assess whether the ACB calculator is a useful tool in assessing those at greatest risk of falls.

Methods

Electronic records were retrospectively reviewed for all residents of a local care centre to the GP practice Ellesmere medical centre using Emis. Age and gender were recorded alongside falls over the past 6 months including those that required hospitalisation as a marker for severity. Medications were documented (excluding topical and inhaled medications) and an ACB score calculated for each patient. Statistical analysis of the data was performed using Spearman’s rank correlation coefficient and the Mann–Whitney U test.

Results

Over a third (34.7%) of the 49 residents had a high ACB score (≥3). 17 falls occurred amongst 11 residents, with 4 requiring hospitalisations during the six-month period. No statistically significant association was found between ACB score and either the number of falls (p= 0.48) or the severity of falls (p= 0.48). Consequently, no medication changes were implemented following the study.

Conclusion

Despite a significant proportion of residents having a high ACB, no correlation with falls frequency or severity was found. This is likely due to current strategies to deprescribe anticholinergic meds and the multifactorial nature of falls makes it difficult to identify the specific contribution of ACB.