Abstract
A lighter load: Tackling ACB (Anticholinergic burden) in geriatric wards:
Background: Exposure to high levels of anticholinergic and sedative medications significantly increases the risk of fall-related hospitalizations, delirium, and mortality in the elderly. While the dangers of traditional anticholinergic medications are well-documented, the cumulative effects of drugs with mild to moderate anticholinergic properties often go unrecognized in everyday clinical practice.
Objectives: To identify the primary contributors to anticholinergic burden (ACB) in geriatric wards and propose practical strategies to reduce ACB by at least 20% over the next three months through sustainable alternatives.
Methods: A comprehensive audit of sixty inpatient medication charts in geriatric wards was conducted in September 2024, based on revised STOPP START criteria, focusing on identifying medications contributing to ACB using an ACB calculator.
Results: 16.17% of medication charts had a high ACB of 3 or greater. Preliminary findings highlighted the necessity of re-evaluating ongoing drug needs, considering non-pharmacological alternatives, emphasizing patient education on ACB risks, tapering or discontinuing anticholinergic medications, and substituting them with safer, evidence-based alternatives with lower ACB. A weekly “medication review” day has been proposed, engaging ward pharmacists, nursing staff, and other members of the multidisciplinary team. We aim to conduct periodic re-audits to identify and address the project's pitfalls for ongoing improvement.
Conclusion: By ensuring the continued training of healthcare professionals and displaying visual learning aids in clinical areas, this initiative is expected to enhance patient well-being by prioritizing ACB reduction and improving adherence to deprescribing strategies.