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Can medication management review reduce anticholinergic burden (ACB) in the elderly? Encouraging results from a theoretical model

Published online by Cambridge University Press:  20 June 2013

Zikai He  and
Patrick Anthony Ball
Zikai He*
Affiliation:
School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales 2650, Australia
Patrick Anthony Ball
Affiliation:
School of Psychological and Clinical Sciences, Charles Darwin University, Casuarina Campus, Darwin, Northern Territory 0909, Australia
*
Correspondence should be addressed to: Zikai He, School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales 2650, Australia. Phone: +61-425-780-775. Email: zikaihe@hotmail.com.
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Abstract

Background:

Review of recent journal articles and various relevant current textbooks provides strong evidence to show that anticholinergic burden is a material issue in frail and at-risk patients. This study assesses the anticholinergic burden in a group of patients in residential care facilities and then applies a theoretical intervention model. It is based on a scoring system known as the Anticholinergic Cognitive Burden (ACB) scale, and attempts to reduce the anticholinergic burden while maintaining therapeutic benefits.

Methods:

A database of 691 patients was analyzed for each individual's ACB based on the scale of scoring produced by groups of experts in the area. A theoretical intervention was then conducted using relevant, evidence-based practice guidelines for clinical therapeutics in Australia. The intervention had the aim of reducing the total ACB without affecting the apparent intended effectiveness of the prescribed therapy.

Results:

Of the 35% (n = 242) patients who score at least 1 point on the ACB, a reduction is achievable in 59% of the cases. In particular, the reduction from a clinically significant score of 3 or above to 2 or below for 49 of those patients is possible in 85% of the cases. Overall, this represents a reduction from 7.10% to 1.01% for the entire population. It is also found that of the 246,960 counts of items dispensed (both prescription and non-prescription) for these patients, 47,334 (or 19.2%) of these were of agents on the ACB scale.

Conclusions:

The study found that it appears to be possible that the total ACB of a group of 691 patients can be significantly reduced.

Keywords

ACBanticholinergic agentsanticholinergicscognitive burdenreduction
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 9 , September 2013 , pp. 1425 - 1431
Copyright
Copyright © International Psychogeriatric Association 2013 

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