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Researchers have developed the Anticholinergic Medication Index to help clinicians identify older patients whose combined medicines may raise their risk of falls or delirium. Its clinical decision-support version is in use at two NHS trusts, while further pilots are examining its feasibility in hospital wards. The tool flags risk; the available report does not establish that using it has reduced falls or delirium.
Researchers have developed a tool that scores the combined effects of anticholinergic medicines to help NHS clinicians identify older patients who may face higher risks of falls or delirium. Its clinical decision-support version is live in electronic patient record systems at two NHS trusts, while further pilots are testing its use on geriatric medicine and hip-fracture wards.
The Anticholinergic Medication Index, or ACMI, was developed by researchers from the University of Leeds, the University of Liverpool and Bradford Institute for Health Research. It estimates a patient’s medication burden against the risks of delirium and falls, allowing clinicians to see which medicines contribute to the score and prioritize patients for a structured medication review.
The index was developed and tested using health records for nearly 750,000 adults over 65. Researchers used de-identified linked primary and secondary care records from Connected West Yorkshire for development, then tested the model with a national dataset of patients in Wales held by the SAIL Databank. The study was published in BMJ Medicine.
A related clinical decision-support system, called ACMICS, places the calculation inside electronic patient records rather than requiring staff to use a separate website. The report says it is in use at two NHS trusts and recalculates when an anticholinergic medicine is started or stopped. A technical specification has also been produced for other organizations considering an equivalent system.
How Medication Scores Could Guide Reviews
Anticholinergic effects occur across medicines used for different conditions, including drugs whose main purpose is not to act as anticholinergics. A patient taking several such medicines may accumulate a burden that is not apparent from considering each prescription separately. A record-based score could help clinicians identify combinations for review without calculating each patient’s exposure manually.
The report cites an estimate that about 50% of older adults in the UK are prescribed at least one anticholinergic medicine each year. Falls and delirium can have serious consequences for older people and create demands on health services. The tool’s potential value is in supporting medication review and safer prescribing; it does not itself change a prescription or show that an adverse event has been prevented.
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From Risk Research to NHS Records
Anticholinergic medicines are used to treat a range of conditions, and some drugs have anticholinergic effects even when those effects are not their primary purpose. Researchers have long raised concerns about cumulative exposure in older patients, including possible links with delirium, falls and dementia, as well as side effects such as dry mouth, constipation and difficulty emptying the bladder.
The ACMI study, titled “Deriving the anticholinergic medication index for delirium and falls in older people: development and external validation of a risk prediction model,” appeared in BMJ Medicine in 2026. The research team designed the index for integration into electronic records, with the aim of making risk information available within clinicians’ existing work. Its current implementation and further ward pilots mark steps toward testing that approach in routine 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 Still Needed on Patient Outcomes
The source report describes development, external validation and implementation, but does not provide results showing that ACMI or ACMICS has reduced falls, delirium, hospital admissions or other harms. It is also not clear how many patients have been assessed by the live systems, how often clinicians act on a flagged score, or what thresholds trigger a review.
A risk score can identify people for closer attention, but it does not establish that a medicine caused a particular patient’s symptoms or that stopping it would be safer. The report does not give details on the performance of the model for specific patient groups or compare outcomes between practices using the tool and those not using it. Broader benefits therefore remain to be demonstrated.
Hospital Pilots Will Test Wider Use
The researchers are piloting ACMI in several geriatric medicine and orthopedic hip-fracture wards to examine whether it can be used more widely in secondary care. The source does not specify the pilot’s timeline, participating hospitals or when results are expected.
Further evaluation would need to establish how the system works in different electronic record environments, whether clinicians find its alerts useful, and whether medication reviews prompted by the score lead to better patient outcomes. The technical specification may help other organizations develop an equivalent system, but the report does not say how many NHS services plan to adopt it.
Key Questions
What is the Anticholinergic Medication Index?
The ACMI is a score designed to estimate an older patient’s combined anticholinergic medication burden in relation to delirium and fall risk. It can show which medicines contribute to the score and help clinicians prioritize medication reviews.
Is the tool already being used in the NHS?
Yes. The report says its electronic-record version, ACMICS, is live and in use at two NHS trusts. Researchers are also piloting the index in several hospital wards.
Has the tool been shown to prevent falls or delirium?
The report describes the tool’s development, testing and implementation, but does not report evidence that its use has prevented 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 flag patients for a clinical medication review, not to make treatment decisions automatically. Any change to medicines needs to be considered by the patient’s qualified health professional in light of their individual needs.
Source: medicalxpress.com
