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

Zikai He, Patrick Ball

    Research output: Contribution to journalArticle


    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.

    Original languageEnglish
    Pages (from-to)1425-1431
    Number of pages7
    JournalInternational Psychogeriatrics
    Issue number9
    Publication statusPublished - Sep 2013


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