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Researchers developed the Anticholinergic Medication Index to help clinicians identify older patients whose combination of medicines may be associated with falls or delirium. A clinical decision-support version is live in two NHS trusts, while pilots in hospital wards are examining whether wider rollout is feasible; the report does not show that the tool has reduced these outcomes.
Researchers have developed and deployed an electronic health-record tool to help NHS clinicians identify people aged 65 and older whose anticholinergic medicines may be associated with a higher risk of falls or delirium. The Anticholinergic Medication Index and its clinical decision-support version are intended to help doctors and pharmacists prioritize medication reviews, but the reported work does not establish that using the tool has reduced falls or delirium.
The index, called the Anticholinergic Medication Index (ACMI), scores a patient’s anticholinergic medication burden in relation to the risk of delirium or falls. Anticholinergic effects can occur in medicines prescribed for different conditions, including drugs for which that effect is not the main purpose. When a person takes several such medicines, the combined burden may be relevant to their health and treatment decisions.
In a pilot at general practices in Bradford, the tool automatically generated lists of patients aged 65 and older, showing their ACMI scores, the medicines contributing to those scores and their predicted risk over one year of a fall or delirium. The researchers say this can help pharmacists identify patients for a structured medication review without having to calculate the information manually for each person.
A related system, the Anticholinergic Medication Index Clinical Decision Support System (ACMICS), has been embedded in electronic patient records and is live in two NHS trusts. According to the research team, it appears at points in the clinical workflow and recalculates when an anticholinergic medicine is started or stopped. The team has also produced a technical specification that other organizations could use to build an equivalent system in their own records infrastructure.
The ACMI was developed and tested using routinely collected, de-identified records for nearly 750,000 adults over 65. Researchers used linked primary and secondary care data from Connected West Yorkshire for development, then tested the index using a national dataset from Wales held in the Secure Anonymized Information Linkage (SAIL) Databank. The study was published in BMJ Medicine in 2026.
How the Tool Could Guide Reviews
Older patients may be treated for several conditions at once, and medicines with anticholinergic effects can accumulate across prescriptions. A system that identifies the medicines contributing to a score could give clinicians a practical way to spot patients who may merit closer review, rather than relying on a separate manual calculation. That is the intended value of putting the tool inside records clinicians already use.
The potential stakes extend beyond the score itself. Falls and delirium can have serious consequences for older people and may add demands on health services. The study’s authors also identify other possible anticholinergic side effects, including dry mouth, constipation and difficulty emptying the bladder. The index is a prompt to review a patient’s medicines, not a direction to stop a particular drug: whether a medicine remains appropriate requires clinical judgment about the person’s conditions and treatment needs.
For the NHS, embedding decision support in electronic records could make risk information easier to access across routine care. However, implementation and predicted risk are not the same as proven benefit. The available report describes deployment and ongoing pilots, but does not provide evidence that ACMI use has already lowered rates of falls, delirium or related hospital care.
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From Risk Research to NHS Records
Anticholinergic medicines are used for a range of conditions, and the effect can be present even when it is not the reason a medicine was prescribed. The research team says the challenge has been translating longstanding knowledge about these risks into a process clinicians can use when reviewing treatment for people taking multiple medicines.
The study, led by researchers at the University of Leeds, University of Liverpool and Bradford Institute for Health Research, developed the index as a risk-prediction model and tested it against data from a separate Welsh dataset. The team then moved toward clinical use: the Bradford general-practice pilot generated patient lists, and ACMICS was embedded in records at two NHS trusts. These are stages of development and implementation; they should not be read as evidence that the system has been adopted across the NHS.
“Approximately 50% of older adults are prescribed at least one anticholinergic medication annually in the U.K.”
— Dr. Kate Best, first author and associate professor of applied statistics at the University of Leeds
Patient Outcomes Still Need Testing
The report does not give results showing that ACMI or ACMICS has reduced the number of falls, delirium cases, hospital admissions or deaths. It describes a risk-prediction tool, pilots and deployment in two trusts, but does not provide a controlled comparison of patient outcomes before and after its use. It is also not clear how many patients have been assessed by the live system or how often its alerts lead to a medication review or a change in treatment.
The accuracy of a risk estimate for an individual patient, the effects of different implementation approaches and the resources needed for wider use are also questions for further evaluation. A high score indicates a reason to consider review; it does not by itself establish that a medicine caused a fall or delirium, or that changing treatment will prevent one.
Hospital Pilots Will Test Wider Use
The research team is piloting the ACMI in several geriatric medicine and orthopedic hip-fracture wards. Those pilots are intended to examine the feasibility of wider rollout in hospital care. The researchers have not specified, in the reported material, when those pilots will conclude or what outcome measures and publication dates are planned.
Further reporting should clarify how the tool performs in day-to-day practice, whether clinicians act on its prompts, and whether patient outcomes change. Other NHS organizations may use the technical specification to develop equivalent systems, but the source does not announce a national rollout or a timetable for one.
Key Questions
What does the Anticholinergic Medication Index do?
The ACMI scores anticholinergic medication burden in relation to predicted risks of delirium or falls. Its purpose is to help clinicians identify older patients who may need a medication review.
Is the tool already being used in the NHS?
A clinical decision-support version, ACMICS, is reported to be live in two NHS trusts. The team is also piloting the tool in hospital wards. The report does not describe a nationwide rollout.
Has the tool been shown to prevent falls or delirium?
The source reports development, validation and implementation, but does not report evidence that using the tool has reduced 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 clinical review; it is not an instruction to stop medication. Decisions about treatment depend on an individual’s health and should be made with qualified clinicians.
Source: medicalxpress.com
