title: Can medication management review reduce anticholinergic burden (ACB) in the elderly? Encouraging results from a theoretical model.
abstract: BACKGROUND
  Review of recent journal articles and various relevant current textbooks provides strong evidence to show that anticholinergic burden is a material issue in frail and at-risk patients. This study assesses the anticholinergic burden in a group of patients in residential care facilities and then applies a theoretical intervention model. It is based on a scoring system known as the Anticholinergic Cognitive Burden (ACB) scale, and attempts to reduce the anticholinergic burden while maintaining therapeutic benefits.
  
  
  METHODS
  A database of 691 patients was analyzed for each individual's ACB based on the scale of scoring produced by groups of experts in the area. A theoretical intervention was then conducted using relevant, evidence-based practice guidelines for clinical therapeutics in Australia. The intervention had the aim of reducing the total ACB without affecting the apparent intended effectiveness of the prescribed therapy.
  
  
  RESULTS
  Of the 35% (n = 242) patients who score at least 1 point on the ACB, a reduction is achievable in 59% of the cases. In particular, the reduction from a clinically significant score of 3 or above to 2 or below for 49 of those patients is possible in 85% of the cases. Overall, this represents a reduction from 7.10% to 1.01% for the entire population. It is also found that of the 246,960 counts of items dispensed (both prescription and non-prescription) for these patients, 47,334 (or 19.2%) of these were of agents on the ACB scale.
  
  
  CONCLUSIONS
  The study found that it appears to be possible that the total ACB of a group of 691 patients can be significantly reduced.
authors.affiliation: School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales 2650, Australia. zikaihe@hotmail.com
authors.forename: Zikai
authors.initials: Z
authors.lastname: He
authors.forename: Patrick Anthony
authors.initials: PA
authors.lastname: Ball
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000453:epidemiology; D017281:Cost of Illness; D017723:Drug Utilization Review / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D054539:Medication Therapy Management; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D012112:Residential Facilities; D011795:Surveys and Questionnaires
chemical_list: D018680:Cholinergic Antagonists