Anticholinergic Burden in Frailty - Greater Manchester Initiative

Introduction:

Anticholinergic medications work by blocking neurotransmitter acetylcholine and may be used in variety of clinical settings.  Older adults are more susceptible to harm from these treatments due to age-related physiological changes and higher prevalence of polypharmacy. Publications such as Pragmatic Prescribing Guide from the British Geriatric Society encourage review with the aim of reducing anticholinergic burden (ACB) in moderate and severe frailty. Despite evidence indicating cognitive and dementia risk, delirium, falls, fractures, functional decline, constipation, dry mouth and cardiovascular effects, as well as possible association with mortality, these medicines continue to be commonly prescribed and used in treatment pathways.

Methods:

A survey was conducted among pharmacists working in Greater Manchester with the aim of ascertaining current state, barriers and facilitators to reviews of ACB. The results will be used to formulate regional strategy with the aim of addressing the risk of harm in frail patients.

Results:

Greater Manchester has fourth highest prevalence of people over 65 years of age who are prescribed one or more anticholinergic medicines with combined ACB score of 6 or greater in England (GM 0.94% vs national average 0.7%). Survey results indicate that majority of frailty pharmacists assess anticholinergic burden as part of their standard practice (92%), 63% used ACB scale while 36% used AEC and there was nowhere in the region which included ACB score on electronic prescribing systems. Barriers described included lack of understanding from clinicians and patients why it matters and time to complete reviews; while facilitators suggested included uniform national guidance creation and best practice definition for reviews.

Conclusion:

Results of the survey will be utilised to formulate pathways aiming to reduce ACB scores as part of patient centred structured medication reviews completed across the region. All regional guidelines will be reviewed to ensure first line treatments offer safest choices in frailty.