Abstract
Introduction:
The anticholinergic burden (ACB) has been increasingly recognized as a modifiable risk factor that can contribute to falls, cognitive impairment, and frailty in older adults. Reducing ACB through medication review can potentially lower fall risk and ease strain on healthcare systems. This study aims to identify common contributors to ACB in older adults admitted with falls and evaluate whether ACB assessment was documented at hospital admission.
Methods:
We conducted a retrospective audit of patients aged >75 years admitted with a coded diagnosis of falls to an elderly care unit between 1 February and 1 March 2025 (n = 30). Data collected included demographics, medication lists, ACB scores (calculated using the ACB calculator), and whether ACB assessment was documented at admission. As no local or national standards currently exist for ACB documentation in this context, the audit was designed to capture baseline practice. Descriptive statistics were used for analysis. Ethics approval was not required as this was an audit of routinely collected clinical data.
Results:
Of the 30 patients, 60% were male and 40% female, with a mean age of 85.2 years. The mean ACB score was 1.5. 30% of patients (n = 9) had an ACB score of 0, 47% (n = 14) had a score of 1–2, and 23% (n = 7) had a score of ≥3, known to have a higher association with cognitive decline and falls. None of the patients had ACB assessments documented on admission. Notably, 43% of patients were prescribed Lansoprazole (ACB score of 1).
Conclusion:
Over 75% of patients admitted with falls had ACB scores below the threshold traditionally considered considerable risk, suggesting that lower scores may also be clinically relevant. A quarter had a significant ACB score (≥3), yet none had documented ACB reviews. Routine ACB screening on admission could support targeted de-prescribing, reduce fall risk, and improve outcomes in hospitalized older adults.
Comments
Medication Question
Hello. Thank you for your work on this topic. How would you take your findings forward in order to reduce anticholinergic burden and it's associated adverse outcomes?
Medication question - reply
Thank you very much for your question. I feel an important step forward is raising awareness among prescribers at an early stage, so that anticholinergic burden is considered when starting long-term medications, not just when problems arise. Integrating ACB scoring into medicines reconciliation and working with pharmacy on deprescribing pathways along with raising awareness plays a crucial role. There is increasing evidence that prolonged exposure may contribute to lasting cognitive and functional decline, so earlier recognition and intervention is very important.
Thank you for your poster,…
Thank you for your poster, there is often a risk/benefit discussion when prescribing ACB drugs in older adults, did your work consider how much impact reviewing of the medications would or could have on these ACB scores?
Thank you for raising this…
Thank you for raising this important point. Our study focussed on medication review as key factor in clinical practice as observational studies have consistently showed that higher acb burden is associated with falls. There is yet no strong evidence base that shows a positive effect on reducing this after presentation with a fall will in practice reduce documented falls. Hence, earlier the intervention, better the outcomes. Falls being most often than now multifactorial, ACB scores represent risks more than actual documented falls. This highlights the need for future work that combines medication optimisation with broader multifactorial falls prevention strategies.
on admission
Thank you for your poster. Should we think about holding anticholinergic drugs on admitting patients post fall or do you think this should be done at a later stage?
Thank you for your comment…
Thank you for your comment. We feel that reviewing anticholinergic drugs at the point of admission may help reduce one of the modifiable risk factors for falls. But to have a more sustained impact, this needs to be carried out more rigorously within the primary care setting as earlier the intervention, you could potentially see a better reflection of it in real time when patients do have a fall for instance - the average age of first elderly fall might increase by a few years.
So, simple answer is earlier…
So, simple answer is earlier the better.