Abstract
Introduction:
Delirium is a common and serious presentation in older inpatients, associated with increased risk of mortality and long term cognitive impairment. Drugs with anticholinergic properties (DAPs)have been linked to poorer cognitive outcomes, and anticholinergic burden may contribute to the development of delirium. This study explores whether higher Anticholinergic Burden Scale (ACB) scores are associated with delirium in older inpatients referred to Old Age Liaison Psychiatry (OALP) at Nottingham University Hospitals (NUH).
Method:
All inpatients aged 65 or older referred to OALP at NUH over a one week period (2nd–9th December 2024) were included. ACB scores were calculated using an online tool, with a score of ≥3 classified as ‘high’. Patients were grouped by referral reason: delirium, low mood, dementia, or other. The prevalence of high ACB scores was compared across categories, and the most commonly prescribed DAPs were recorded.
Results:
Of 43 patients referred, 12 (27.9%) had high ACB scores and 35 (81.4%) were on at least one DAP. Among those referred with delirium (n=7), 2 (28.6%) had high ACB scores - similar to rates in other referral groups (low mood: 20.0%, dementia: 25.0%, other: 41.7%). Proton pump inhibitors (e.g., lansoprazole, omeprazole) and oxycodone were the most frequently identified DAPs.
Conclusion(s):
This small study found no clear association between high ACB scores and delirium compared to other referral reasons. However, the high prevalence of DAP use highlights the importance of considering anticholinergic burden in older patients. ACB assessment could be a useful addition to medication reviews in both general and psychiatric settings to support safer prescribing and improve outcomes.
Comments
Unexpected finding..Useful to know!
Was there any possible relationship between a trial of deprescribing DAPs and a reduction in referrals to OALP, despite this small study not showing a clear association?
An interesting study.
An interesting piece of work, thank you for sharing this with us all.
Your study focused on a small sample size (43 patients). Do you think a larger sample size or longer study period would influence the results? Are there any plans for further studies with broader cohorts or perhaps looking at how deprescribing DAPs could possibly improve patient outcomes?
Thank you