Observational study of Anticholinergic Burden (ACB score) reduction in elderly patients presenting with falls in Frailty Unit

Introduction

Medications with anticholinergic burden are associated with falls and cognitive decline in elderly. About 30% of people aged 65 years and over in the UK have a fall at least once each year, increasing to 50% at the age of 80 and over.

Method

The last 100 patients admitted to the Frailty unit with falls were identified and Anticholinergic Burden (ACB) scores calculated on admission and at discharge. 
Patients were defined as having a positive (ACB≥1) or negative (ACB=0) ACB score. Drugs responsible for ACB score were identified and medication changes assessed.

Results

75 out of 100 patients assessed were found to have a positive ACB score.
Most common drugs causing anticholinergic burden were found to be PPIs(in 51% of study population), antidepressants (27%), metformin (11%), benzodiazepines (10%), risperidone (4%), nefopam (4%), morphine (3%), tolterodine (3%) and antihistamines (3%).
It was found that only 10 of the 75 patients (13.3%) with a positive ACB score were discharged on a lower ACB score. 
8 patients were found to have a higher ACB score on discharge than on admission due to added opiate analgesics or antiemetics.

We found that 20 patients with ACB score equal to or more than 3 were discharged on the same medications. 14 of these had essential psychiatric drugs which could not be omitted on discharge however the others had potential to switch out to other medication with lower anticholinergic burden.

Conclusion

This study highlights the prevalence of high anticholinergic burden in the elderly population presenting with falls. Attempts to reduce the burden were seen but some patients were discharged on the same ACB score or higher. This indicates the need to consider anticholinergic burden in elderly patients to attempt to reduce falls and improve overall patient care.