Burden or Benefit? Unmasking anticholinergic burden(ACB) in Care of elderly wards

Introduction

The elderly are susceptible to the adverse effects of anticholinergic drugs. A high anticholinergic burden from their use has been linked to falls, delirium, functional decline and death. NICE guidelines urges review of these drugs in vulnerable elderly with diagnosed or suspected dementia and falls, and have highlighted the use of ACB scoring tools to facilitate our approach.

Aim

It was observed that ACB assessments were not routinely done in our geriatric wards. We aim to improve compliance with NICE recommendations on ACB assessment in high risk patients and encourage use of a scoring tool to guide deprescribing.

Method

A prospective study across all five geriatric wards. Inclusion criteria would be patients admitted to the CoE wards due to: 

1) Falls (Group 1)

2) Other issues with a background of dementia (Group 2)

Exclusion criteria: Patients on end of life care

Results

ACB Assessment 

Among Group 1, ACB assessment was carried out in 6 out of 24 patients (25%); 3 patients were assessed with a scoring tool. Among Group 2, ACB assessment was carried out in 3 out of 16 patients (18.8%); none were assessed using a scoring tool. 13 patients out of all patients had a high ACB score (as calculated by the author).

Deprescribing 

4 of the high ACB patients had plans; 3 with documented assessments. Amitriptyline and solifenacin were deprescribed; solifenacin continued in one as it provides clinical benefit.

Conclusion

The practice of ACB assessments were inconsistent across both patient groups and the utility of an ACB tool was poor. Our findings suggest that a purposeful effort to reduce ACB is more likely to occur in patients whose ACB was assessed clearly via scoring using a tool. Raising awareness among resident doctors of the significance of tackling ACB in the elderly and the use of a tool to facilitate deprescribing would be crucial to improve compliance with current guidelines and improve patient care.