Abstract
Introduction
In older adults, anticholinergic burden (ACB) is associated with serious adverse effects
including delirium, falls, functional decline, cognitive decline and death. We carried out a quality improvement project in a geriatric ward, aiming to reduce the percentage of older adults with high ACB scores on discharge by 15% from a baseline of 48% over a period of 3 months.
Method
A pre-interventional analysis of all patients discharged from a single acute geriatric ward in
Changi General Hospital was performed. A pre-intervention survey was conducted to assess awareness among physicians of ACB and tools used. Fish-bone diagram, pareto chart and driver diagram were used to identify root causes, highlight the barriers and to prioritise
interventions. Interventions in the form of educational posters on ACB, non-
pharmacological management of delirium and behavioural symptoms of dementia were made available at the ward. ACB scores were generated for all patients on discharge, using
an online ACB calculator 1 , which combined the use of 2 validated scales: anticholinergic
cognitive burden scale 2 and the German anticholinergic burden scale 3 .
Results
396 patients were included in the analysis. Median percentage of patients with high ACB scores (≥3) on discharge was reduced from 48.4% pre-intervention to 16.1% post- intervention. Out of 14 physicians surveyed pre-intervention, 21.4% was unaware of theterm “ACB” and availability of ACB scoring systems.
Conclusion
An education approach is effective in raising awareness and reducing use of anticholinergic medications in an acute geriatric ward. This highlights the importance of incorporating ACB awareness and the tools into geriatric department teaching programmes.
References
1. ACB Calculator. (n.d.). https://www.acbcalc.com/
2. Boustani M, et al. Ageing Health. 2008. 4(3). 311-320.
3. Kiesel EK, et al. BMC Geriatr. 2018. 18. 239.