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Researchers developed the Anticholinergic Medication Index to help clinicians identify older adults whose combination of medicines may raise their risk of delirium or falls. A related clinical decision-support system is live in two NHS trusts, while pilots in additional hospital wards will assess the feasibility of wider use. The available report does not show that the tool has already reduced falls or delirium.
Researchers have developed a tool to help health care professionals identify adults aged 65 and older whose use of multiple anticholinergic medicines may put them at increased risk of delirium or falls. A clinical decision-support version is live in two NHS trusts, but the report does not establish that using it has already reduced either outcome.
The Anticholinergic Medication Index, or ACMI, scores a patient’s anticholinergic medication burden in relation to the risk of delirium or falls. Anticholinergic effects can occur in medicines prescribed for different conditions, including drugs for which that effect is not the main purpose. When a patient takes several such medicines, their combined burden may be relevant to prescribing decisions.
The research team piloted ACMI in Bradford general practices. The system automatically produced lists of patients aged 65 and older, with each person’s score, the medicines contributing to it and a predicted one-year risk of a fall or delirium. The researchers said this information could help pharmacists prioritize patients for structured medication reviews, rather than requiring staff to calculate it individually beforehand.
A related clinical decision-support system, called ACMICS, has been embedded directly in electronic patient record systems and is in use at two NHS trusts. It recalculates scores when an anticholinergic medicine is started or stopped and displays information at points in the clinical workflow. The team also developed a technical specification that other organizations could use to build an equivalent system in their own records platform.
The index was developed and tested using health records for nearly 750,000 people over 65. Researchers used de-identified linked records from Connected West Yorkshire for development and a national Welsh dataset held in the Secure Anonymized Information Linkage, or SAIL, Databank, for external testing. The study was published in BMJ Medicine in 2026.
How Medication Reviews Could Change
Older patients often live with several conditions and may be prescribed multiple medicines. A tool that brings medication burden and predicted risk into existing records could help clinicians spot patients who might merit a closer review, particularly when a medicine’s anticholinergic effect is not obvious from its primary use. The potential benefit is better-informed prescribing, not an instruction to stop treatment.
Falls and delirium can have serious effects on older people’s health and independence, while also creating demands on health services. The researchers say the tool could support safer prescribing by making risk information quicker to access. Whether routine use leads to fewer incidents, better patient outcomes or lower NHS costs remains to be established; the source report describes implementation and pilots, not demonstrated reductions.
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From Risk Evidence to NHS Records
Anticholinergic medicines are used for a range of conditions, and their effects can be present in drugs prescribed for other reasons. The combined exposure is often described as anticholinergic burden. The research report says this burden has been associated with problems including falls and delirium, as well as dementia and side effects such as dry mouth, constipation and difficulty emptying the bladder.
The researchers said a practical challenge has been translating awareness of these risks into action during routine care. ACMI was designed to work within electronic patient records rather than as a separate online calculator. The team says it drew on observations of clinical practice when deciding where the score should appear, and tested the index against a separate dataset after developing it using West Yorkshire records.
Dr. Kate Best, the study’s first author and an associate professor of applied statistics at the University of Leeds, said about 50% of older adults in the UK are prescribed at least one anticholinergic medicine each year. She cautioned that such a medicine may still be the best treatment for an individual; the concern is that burden can accumulate across prescriptions.
“Approximately 50% of older adults are prescribed at least one anticholinergic medication annually in the U.K.”
— Dr. Kate Best, associate professor of applied statistics at the University of Leeds and first author
Impact Beyond Two NHS Trusts
The report does not provide outcome data showing whether ACMI or ACMICS has reduced falls, delirium, dementia or hospital admissions. Nor does it specify how many patients have been assessed through the live systems, how often scores prompt medication changes, or whether those changes improve outcomes. The index estimates risk; it does not establish that a medicine caused a particular patient’s symptoms or that stopping it would be appropriate.
Wider implementation is also not settled. The team says the system is live at two trusts and that pilots are under way in several geriatric medicine and orthopaedic hip-fracture wards to assess feasibility. The source does not give a timetable for those pilots, identify a national rollout decision or report how the tool will be evaluated across additional sites.
Further Hospital Ward Pilots
Researchers are piloting ACMI in geriatric medicine and orthopaedic hip-fracture wards to assess whether wider use in hospital care is feasible. Those pilots are the next reported step; no completion date or decision on broader NHS adoption has been announced in the source material.
Other health organizations could use the team’s technical specification to develop an equivalent system within their own electronic records. Any wider assessment will need to establish how clinicians use the scores, whether the tool changes medication reviews and, ultimately, whether those changes are associated with better patient outcomes. Until that evidence is available, the confirmed development is the tool’s implementation—not proof that it cuts falls or delirium.
Key Questions
What is the Anticholinergic Medication Index?
ACMI is a scoring tool that estimates anticholinergic medication burden in relation to a patient’s risk of delirium or falls. It is intended to help clinicians identify people who may need a medication review.
Is the tool already being used in the NHS?
A related system, ACMICS, is embedded in electronic patient records and is reported to be live in two NHS trusts. The report does not say it has been adopted nationally.
Has the tool been shown to prevent falls or delirium?
The source describes the tool’s development, testing and implementation, but does not report evidence that it has reduced falls or delirium. Further evaluation is needed to establish its effect on patient outcomes.
Does a high score mean a patient should stop a medicine?
No. The score is intended to inform clinical review, not to direct patients to stop treatment. The researchers note that an anticholinergic medicine may still be the best option for an individual; medication decisions should be made with a qualified health professional.
Source: medicalxpress.com
