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Researchers have developed the Anticholinergic Medication Index to help clinicians identify older people whose combination of medicines may put them at higher risk of falls or delirium. Its clinical decision support system is live in two NHS trusts, while further pilots are examining whether it can be used more widely. The tool flags risk and supports medication review; the report does not show that it has already reduced falls or delirium.
Researchers have developed an electronic health-record tool to help NHS clinicians identify people aged 65 and older who may face a higher risk of falls or delirium linked to multiple medicines with anticholinergic effects. The system, based on the Anticholinergic Medication Index (ACMI), is live in two NHS trusts; researchers are also piloting it in hospital wards as they assess its potential for wider use.
The index assigns a score to a patient’s anticholinergic medication burden and is designed to identify medicines contributing to that score. In a pilot at GP practices in Bradford, the system automatically produced lists of patients aged 65 and older, including their score and predicted one-year risk of a fall or delirium. The information can help pharmacists prioritize patients for a structured medication review.
Without automated calculation, clinicians would have to assemble this information patient by patient before deciding who might need review. Researchers designed the tool for integration into electronic patient record systems, rather than requiring staff to use a separate online calculator.
The clinical decision support version, called the Anticholinergic Medication Index Clinical Decision Support System (ACMICS), has been embedded in hospital record systems at two NHS trusts and is in use, according to the report. It recalculates when an anticholinergic medicine is started or stopped and appears at points in the electronic record intended to fit clinical workflows. A technical specification has also been produced to help other organizations build an equivalent tool.
The underlying 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 dataset from Wales held in the Secure Anonymized Information Linkage (SAIL) Databank for external testing. The study was published in BMJ Medicine in 2026.
How the Tool Could Guide Reviews
Anticholinergic medicines are used for a range of conditions, and some drugs have these effects even when they are not their main purpose. Taking several medicines with anticholinergic effects can add to a person’s overall burden. For older people taking multiple prescriptions, an automated prompt could help clinicians spot combinations that warrant closer review.
The tool is intended to support clinical decisions, not automatically stop or change treatment. Some anticholinergic medicines may be the most appropriate option for an individual patient, so a score needs to be interpreted alongside that person’s conditions and care needs. The practical value will depend on whether the system helps teams identify patients and conduct reviews effectively.
Falls and delirium can have serious consequences for older people and can require hospital care. The researchers say these problems also carry costs for the NHS. But the report describes risk prediction and implementation, not evidence that use of ACMI has already reduced either outcome.
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From Risk Research to NHS Records
Anticholinergic burden has been linked to health concerns including delirium and falls, as well as other effects such as dry mouth, constipation and difficulty emptying the bladder. The challenge, as the researchers frame it, is turning established concerns about medication combinations into a process clinicians can use while caring for patients.
First author Dr. Kate Best of the University of Leeds said about 50% of older adults in the UK are prescribed at least one anticholinergic medicine each year. That figure refers to receiving at least one such prescription annually; it does not mean that half experience a medication-related fall or delirium.
The research brought together teams from the universities of Leeds and Liverpool and the Bradford Institute for Health Research. Separate implementation work embedded the decision support system in hospital records at two NHS trusts. Researchers are now piloting the tool in geriatric medicine and orthopedic hip-fracture wards to examine the feasibility of extending its use in secondary care.
“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 the study’s first author
Evidence on Patient Outcomes
The report does not establish whether ACMI use has led to fewer falls, less delirium, or better health outcomes. It describes development, testing and deployment of a risk prediction system, alongside pilots; the available material does not provide results from a comparison of patient outcomes with and without the tool.
It is also not clear how many patients have been assessed through the live systems, how often a high score leads to a medication review, or what changes clinicians make after reviewing a prescription. The report does not specify a timetable for wider NHS adoption or whether every trust can integrate the system using the technical specification.
A risk score identifies people for consideration; it does not prove that a medicine caused a symptom or that changing it will prevent one. Medication decisions remain dependent on individual clinical circumstances.
Hospital Pilots and Wider Use
The research team is piloting ACMI in several geriatric medicine and orthopedic hip-fracture wards to assess whether the approach is feasible in secondary care. These pilots may help show how the system fits into hospital workflows and how clinicians use its prompts when reviewing medicines.
The technical specification offers other organizations a route to develop an equivalent tool within their own electronic patient record systems. The report does not give a national rollout date. Further evaluation, including evidence about implementation and patient outcomes, will be needed to establish whether wider use reduces falls or delirium.
Key Questions
What is the Anticholinergic Medication Index?
The ACMI is a score intended to help clinicians assess an older patient’s burden from medicines with anticholinergic effects and identify those who may need a medication review.
Is the tool being used in the NHS?
Yes. The clinical decision support version, ACMICS, is reported to be live in electronic patient record systems at two NHS trusts. Further pilots are under way in hospital wards.
Has the tool been shown to prevent falls or delirium?
The report does not provide evidence that the tool has already reduced falls or delirium. It describes a risk prediction model and its implementation; further outcome evidence is needed.
Does a high score mean a patient should stop a medicine?
No. The score is intended to help prioritize a clinical review, not direct patients to stop treatment. A clinician must weigh the potential risks and benefits of medicines for each person.
How was the index tested?
Researchers developed and tested the index using records for nearly 750,000 adults over 65, drawing on de-identified data from West Yorkshire and an external dataset from Wales.
Source: medicalxpress.com
