Can medication management review reduce anticholinergic burden (ACB) in the elderly? Encouraging results from a theoretical model

Int Psychogeriatr. 2013 Sep;25(9):1425-31. doi: 10.1017/S1041610213000872. Epub 2013 Jun 20.


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.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Australia
  • Cholinergic Antagonists / adverse effects*
  • Cognition / drug effects*
  • Cognition Disorders / chemically induced*
  • Cognition Disorders / epidemiology
  • Cost of Illness*
  • Drug Utilization Review / statistics & numerical data*
  • Female
  • Frail Elderly
  • Humans
  • Male
  • Medication Therapy Management*
  • Models, Theoretical*
  • Practice Guidelines as Topic
  • Residential Facilities
  • Surveys and Questionnaires


  • Cholinergic Antagonists