Comparison of polypharmacy and ACB in a cohort of older adults living with frailty at a DGH in Southwest Wales between 2023-2025

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Talia Bartley1, James Flynn2, Zena Marney3
Department of Elderly Care, Prince Philip Hospital, Hywel DDa
Clinical Quality
CQ - Patient Centredness
Prescribing and medication management

Abstract

Introduction

Polypharmacy is defined as use of 5+ medications. An anticholinergic burden score (ACB) 3+ increases risk of adverse outcomes in frail patients including falls, cognitive decline, and mortality. Optimising older adults’ medication regimen is a critical element of Comprehensive Geriatric Assessment (CGA).

Method

In December 2025 a frailty census was completed at Prince Philip Hospital (PPH). Criteria for inclusion were age ≥65 years. Data was collected for a range of metrics including Clinical Frailty Scale score (CFS), polypharmacy, anti-cholinergic burden, and whether admitted with a frailty syndrome. Comparison was made to results from the PPH frailty census in June 2023.

Results

Data was collected for 168 patients with mean age of 80.1 years. The most common CFS was 6 (32%). Polypharmacy was present in 138 patients (82.1%) and 128 (76.2%) had an ACB score ≥1. 62 patients (36.9%) had both polypharmacy and a frailty syndrome compared to 76 (45.2%) with polypharmacy and no frailty syndrome. Chi2 test demonstrated a non- statistically significant correlation between the presence of frailty syndrome and polypharmacy (p = 0.134). 77 patients (45.8%) had ACB score 1-2, and 51 (30.4%) had an ACB score 3+. A significant portion of patients with ACB score 3+ had higher CFS.

Data in 2023 included 77 patients with a mean age 80.2 years old. 88% had polypharmacy, compared to 82.1% in 2025. In 2023 40.25% of patients had an ACB score of 3+, compared to 30.4% in 2025. Both 2023 and 2025 data observed a correlation between the presence of frailty syndromes and polypharmacy/ACB burden.

Conclusion

Despite the ongoing improvement and utilisation of the CGA throughout community and acute frailty services between 2023 and 2025, there is still improvement to be achieved in reducing polypharmacy and anti-cholinergic burden. This suggests further need for local service development and training.

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