280 Prevalence of prescribing high anticholinergic scoring medications among over 65-year-old patients in primary care

Abstract

Abstract Background The effects of anticholinergic drugs are widespread because acetylcholine is involved in regulating various bodily functions, both in the Central Nervous System (CNS) and the Peripheral Nervous System (PNS). By blocking the action of acetylcholine at CNS muscarinic receptors, anticholinergic drugs can lead to cognitive effects such as impaired attention, decreased learning ability, and memory difficulties. Blocking the PNS muscarinic receptors with anticholinergic drugs can lead to side effects such as urinary retention, constipation, and alterations in heart rate. Considering these issues, it is generally advisable to use anticholinergic drugs with caution in the elderly population as an anticholinergic score of 3 or more is associated with increased risk of confusion, falls and death. This audit seeks to determine the prevalence of the higher scoring Anticholinergic drugs (3) among the older population in a city centre GP Practice. Methods The website www.acbcalc.com provides a comprehensive list of medications with an Anticholinergic burden score of 3. Using this list of 48 commonly prescribed medicines, each one was searched on the practice clnical system individually and the number of patients currently prescribed each medicine documented. Results Approximately 5.45% of patients over 65 yrs (N = 2,770) are currently prescribed a medicine with an Anticholinergic score of 3. The most commonly prescribed are Amitriptyline (1.52%), Solifenacin (1.01%), Quetiapine (0.79%), Olanzapine (0.61%). Conclusion While anticholinergic medications can prove useful clinical interventions in certain patients, it is generally accepted that a burden score of 3 or more increases the patient’s risk of confusion, falls and death. Patients who have a high Anticholinergic score should have their medicines optimised through a shared decision making framework regularly, to ensure current therapy is beneficial and alternatives considered. An automated audit tool could be created within the primary care clinical system to score each patient’s anticholinergic burden and thus help target polypharmacy reviews.