Anti-Cholinergic Burden (ACB) Score in Assessment of Elderly Patients

Introduction

The Anti-cholinergic Burden (ACB) is the cumulative effect of using different drugs with anti-cholinergic effect concomitantly. This can have adverse effects on the Peripheral or Central Nervous systems. Research shows that patients with a high ACB score (≥3), have a 60% increased risk of fall-related hospital admissions, 50% increased risk of dementia, and 30% increased mortality in the older population.

Methods

I audited all the patients on the Care of the Elderly (COTE) ward over the period of 6 weeks aiming to assess the ACB score of patients on admission and after optimization on the ward, to correlate the ACB score and cause of admission, and to recognize the most prescribed medications associated with ACB.

This involved data collection through retrospective analysis of GP records for medications on admission and reviewing of the hospital electronic prescribing system after management on the ward with calculation of ACB scores subsequently using an online ACB calculator.

Results

A total of forty-five patients were included in the analysis. Of these, thirty-two patients (71%) were prescribed medications with ACB, and 10 patients had a high ACB score (≥3).

Among patients presenting with delirium, 67% were taking medications with ACB, while 33% were not. Similarly, among those presenting with falls 72% were on ACB-associated medications and 28% were not.

Proton pump inhibitors were the most common contributors to ACB, accounting for 44% of cases, followed by selective serotonin reuptake inhibitors at 22%.

Of the thirty-two patients prescribed medications with ACB, treatment was modified in a minority of cases; ACB was reduced in eleven patients (34%).

Conclusion

It is important that all patients aged ≥65 years should have their cumulative ACB score calculated on admission and receive a structured medication review reassessing the ongoing indication for each medication and prescribing alternatives or deprescribing where appropriate.