RESEARCH
Tracking the anticholinergic burden score during hospital admission in an acute hospital in England
Here we report on a retrospective study undertaken in a UK hospital that found that the overall anticholinergic drug burden did not change significantly during an inpatient stay on five wards typically caring for older people
GETTY
Mike Wilcock BSc ( Hons ) MPhil Stephen Chan MPharm PG Dip Liam Bastian MPharm PG Dip Andrew Bastin MPharm PG Dip Pharmacy Department , Royal Cornwall Hospitals NHS Trust , Truro , UK
Anticholinergic medications ( ACM ) are prescribed for the management of conditions such as depression , psychosis , Parkinson ’ s disease , overactive bladder , and chronic obstructive pulmonary disease . These are among the most prescribed medications in patients with polypharmacy . One systematic review looking at adverse effects found that certain individual ACM or increased overall exposure to ACM may increase the risks of cognitive impairment , falls and all-cause mortality in older adults , 1 though others argue that the evidence for harmful outcomes in certain groups of older patients remains uncertain or deficient . 2 , 3
What is the anticholinergic burden ? Anticholinergic burden ( ACB ) is defined as the “ accumulation of higher levels of exposure due to one or more ACM and the attendant increased risk of medication-related adverse effects ”. 4 A number of anticholinergic quantification scales have been reported in the literature , providing a list of ACM and a rank of low- to high-risk based on anticholinergic activity . However , most scales are constructed using expert opinion panels , in vitro data and literature reviews . These scales each include different drugs and have variations in the rating of the included drugs , meaning variability and inconsistency among the scales exist . 5 , 6 As an example , it is suggested that the relationship between ACB and fracture risk might differ depending on the ACB scale used . 7
Inappropriate prescription of ACM to older patients in primary care has been reported extensively . 8 . 9 In England , the NHS Business Services Authority anticholinergic burden prescribing comparator can be used to identify the number
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