Applied Research Collaboration North West Coast (ARC NWC) researchers based at the University of Liverpool in collaboration with colleagues from the University of Leeds, ARC Yorkshire & Humber and the Bradford Institute for Health Research, have contributed to the development of a new tool designed to help identify older people at risk of medication-related harm.
The study, funded by HDR UK and published in BMJ Medicine, has developed the Anticholinergic Medication Index (ACMI), which aims to help healthcare professionals identify patients at increased risk of falls and delirium associated with anticholinergic medicines.
Sarah Rodgers, Professor of Health Informatics at the University of Liverpool, ARC NWC and NIHR senior investigator said this about the recent project:
“Older people living with frailty are often prescribed several medicines, and understanding their combined effects can be difficult. This research demonstrates how routinely collected NHS data can be turned into practical information to support better decisions at the point of care.
By developing a medicines tool (“The ACMI”) in one population and successfully testing it in another, we’ve taken an important step towards helping GPs and pharmacists identify who would benefit most from a careful medication review.”
Anticholinergic medicines are commonly prescribed to treat a range of conditions. However, taking multiple medicines with anticholinergic effects can increase the risk of adverse outcomes, particularly among older people. The ACMI has been developed to provide a practical way of measuring this medication burden and identifying patients who may benefit from a review of their prescriptions.
Professor Andy Clegg, Head of the Academic Unit for Ageing and Stroke Research and Co-Director of HDR UK North and NIHR ARC Yorkshire and Humber said:
“Anticholinergic burden is a significant concern for older people, contributing to major health problems including delirium, falls, and dementia, alongside other side effects such as constipation, problems emptying the bladder, and dry mouth. As a consultant geriatrician, I frequently see patients on multiple anticholinergic medications that may be contributing to delirium and falls.
“We have designed the ACMI to integrate with electronic patient record systems and have successfully deployed the tool to support safer prescribing in primary and secondary care. Our ACMI has been designed to be built into EPR systems, rather than using a separate online system, providing a highly efficient automated calculation for busy clinicians to make the best decisions for their patients.”
Researchers used data from Connected West Yorkshire to develop the tool, before validating it using national health data from Wales, held within the Secure Anonymised Information Linkage (SAIL) Databank. The study analysed data from almost 750,000 adults aged over 65. University of Liverpool and ARC NWC researchers, Olly Butters and Dr Georgie Schofield, played key roles in the project, contributing their expertise in health data analysis to support the development and evaluation of the new index.
Dr Schofield had this to say about the project:
“The interpretation of findings from routinely collected healthcare data requires critical examination of the processes through which clinical phenomena are translated into coded records. Codes are not neutral or complete representations of clinical reality; they are products of clinical, organisational and administrative practices. Understanding these processes is essential for distinguishing genuine clinical patterns from artefacts of recording, coding and healthcare delivery.”
Designed for integration into electronic patient record systems, the ACMI could help clinicians and pharmacists identify patients who may benefit from a structured medication review. The research team is now exploring its use in hospital settings, including geriatric medicine and orthopaedic wards, to assess its potential for wider implementation.
The study demonstrates the value of collaboration between universities, research partnerships and healthcare organisations in translating health data research into practical approaches that could improve patient care.