TL;DR
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Researchers have developed the Anticholinergic Medication Index to help clinicians identify older adults whose combined medication effects may raise their risk of falls or delirium. The tool was tested using health records for nearly 750,000 people over 65 and has been deployed in two NHS hospital trusts; wider use is still being evaluated.
Researchers have developed a tool to help doctors and pharmacists identify older adults at higher predicted risk of falls or delirium associated with taking multiple anticholinergic medicines. The Anticholinergic Medication Index, or ACMI, can be incorporated into electronic patient records to flag patients for a possible medication review, and versions are already in use at two NHS hospital trusts.
The ACMI scores a patient’s combined exposure to medicines with anticholinergic effects, using risks of delirium and falls as the basis for the index. Some medicines are prescribed specifically for their anticholinergic effects, while others can have those effects even when that is not their main purpose. The resulting burden can build up when a person takes several such medicines.
In a pilot at GP surgeries in Bradford, the tool generated lists of patients aged 65 and older, their ACMI scores, the medicines contributing to those scores and their predicted one-year risk of a fall or delirium. The report says this information would otherwise have to be assembled patient by patient before pharmacists could prioritise structured medication reviews.
The study, published in BMJ Medicine, was developed using de-identified routinely collected records for nearly 750,000 adults over 65 in West Yorkshire and tested against a large national dataset in Wales. Researchers from the universities of Leeds and Liverpool and Bradford Institute for Health Research led the work. The study describes a tool for identifying risk; it does not establish that using the index prevents falls or delirium.
How the Index Could Guide Reviews
Anticholinergic medicines are used for a range of conditions, and a medicine with these effects may still be the appropriate treatment for an individual patient. The concern is that effects from several medicines can accumulate, while clinicians may not readily see the combined burden across a patient’s prescriptions. The research report says about half of older adults in the UK are prescribed at least one anticholinergic medicine each year.
By calculating scores within electronic records, the ACMI could help care teams identify people who may warrant a closer look without manually checking every patient first. That may support more focused medication reviews in primary and secondary care. But a high score is a prompt for clinical assessment, not a direction to stop a medicine: any change must account for the condition being treated and the patient’s circumstances.
Falls and delirium can have serious consequences for older people and can add to demand on health services. Researchers say the tool offers a practical way to apply existing knowledge about medication risks. Its actual effect on patient outcomes, prescribing decisions and service costs has not been established in the supplied report.
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From Risk Evidence to Electronic Records
Anticholinergic burden refers to the combined effects of medicines with anticholinergic properties. The report links higher burden with risks including delirium, falls and dementia, and also notes possible side effects such as constipation, difficulty emptying the bladder and dry mouth. The index focuses its scoring on predicted delirium and falls risk.
The work addresses a practical barrier: clinicians may know about the risks but lack an efficient way to assess the combined effects of several drugs for individual patients. The team designed the ACMI to sit inside existing electronic patient record systems rather than require a separate online calculator. A related clinical decision support system, ACMICS, is live at two NHS trusts and recalculates when an anticholinergic medicine is started or stopped, according to the report.
The research used linked, anonymised healthcare records from Connected West Yorkshire for development and a Welsh dataset held by the Secure Anonymised Information Linkage Databank for testing. The report identifies the paper as “Anticholinergic medication index: Advancing safer prescribing for older adults,” by P. S. Nishtala and G. Gill, published in BMJ Medicine in 2026.
“For patients with multiple health conditions, it may be reassuring to know there is a tool that can flag when they might need a medication review.”
— Dr. Kate Best, first author and associate professor of applied statistics at the University of Leeds
What Patient Benefits Remain Unproven
The report describes development, testing and early implementation, but does not provide results showing whether ACMI use reduces falls or delirium, changes prescribing, or improves health outcomes. It also gives no figures on how many patients have been assessed by the live hospital system, how often clinicians act on a score, or the index’s accuracy at particular score thresholds.
It is not clear from the supplied material how the tool performs across different patient groups or healthcare systems, or what resources organisations would need to install and maintain it. A technical specification has been produced for other organisations seeking to build an equivalent system, but wider adoption and its effects remain to be assessed. The index flags predicted risk; it does not prove that a specific medicine caused a patient’s symptoms or that stopping it would be beneficial.
Hospital Pilots Will Test Wider Use
The research team is piloting the ACMI in several geriatric medicine and orthopaedic hip-fracture wards to examine whether broader use in hospital care is feasible. The report does not give a timeline for the pilots or say when results will be published.
Further evaluation would be needed to establish whether the tool changes medication reviews and prescribing in ways that improve patient outcomes. Health organisations considering the system can also use the technical specification described by the team to develop an equivalent tool within their own electronic records, though implementation at additional sites has not been confirmed.
Key Questions
What does the Anticholinergic Medication Index do?
The ACMI scores a patient’s anticholinergic medication burden and is designed to help clinicians identify older people who may need a medication review because of predicted fall or delirium risk.
Does a high score mean someone should stop taking a medicine?
No. The score is intended to flag a patient for clinical review; it does not determine whether a particular medicine should be stopped. Treatment decisions depend on the patient’s health and the reasons each medicine was prescribed.
How was the tool developed and tested?
Researchers developed the index using de-identified health records for nearly 750,000 adults over 65 in West Yorkshire and tested it using a large national patient dataset from Wales.
Is the tool already being used in the NHS?
The related ACMICS decision support system is reported to be live and in use at two NHS trusts. The team is also piloting the ACMI in several hospital wards; wider rollout has not been confirmed.
Has the tool been shown to prevent falls or delirium?
The supplied report describes the tool’s development, testing and implementation, but does not report evidence that it has reduced falls or delirium. The team is continuing feasibility work in hospital settings.
Source: news-medical.net
