The Anticholinergic Burden Calculator:  What is the fall risk?

Did you know…42% of older adults take 5 or more prescription medications. According to Lown Institute, nearly 20% take 10 drugs or more medications daily.

Unfortunately, older people are prescribed multiple medications. Many of these medications that are prescribed have anticholinergic properties. Anticholinergics are drugs that block the action of acetylcholine. Acetylcholine is a neurotransmitter, or a chemical messenger. It can transfer signals between certain cells to affect how your body functions. Anticholinergic drugs are prescribed to treat a variety of medical conditions, including Parkinson’s disease, allergies, anxiety, chronic obstructive pulmonary disease (COPD), insomnia, and urinary incontinence. As the body ages, its ability to metabolize medications decreases. The permeability of the blood-brain barrier increases; therefore older patients are more susceptible to the anticholinergic effects of their medications. In adults over 65 years of age these can cause consequences of confusion, dizziness, and falls.

Medications with anticholinergic properties can be associated with Adverse Drug Reactions (ADRs). Examples of such ADRs include dry eyes, urinary retention, dizziness, cognitive impairment, and falls. The anticholinergic effect increases if a stronger anticholinergic is used, or if different anticholinergics are used in combination.

I recently was able to participate in a Fall Prevention Specialist Certification program.  There were so many valuable tools provided, but the one that stuck out the most to me was the ACB Calculator, created by Dr. Rebecca King and Steve Rabino.

The calculator can be used to work out the Anticholinergic Burden for the people you support. A score of 3+ is associated with an increased cognitive impairment and mortality.

The purpose of the Anticholinergic Burden Calculator is to aid physicians. It can help in decision-making during a medication review. It also offers alternatives with a lower Anticholinergic burden, which may or may not be appropriate for that person.

Case Example

Here is a report example. When I put the medication Benadryl and Cogentin in the ACB Calculator, the results came back with a score of 6 which is a high risk. See details below:

Benadryl™

Score: 3        

Cogentin™

Score: 3        

Total ACB Score: 6

High Risk

Your patient scored ≥3 and is therefore at a higher risk of confusion, falls, and death. Please review their medications and, if possible, discuss this with the patient and/or relatives/carers. Please consider if any of these medications could be switched to a lower-risk alternative.

Drugs with possible anticholinergic burden score 1.

Drugs with definite anticholinergic burden score 2 or 3.

If you cannot find your medication listed in the calculator, you can assume it scores 0.

Try out the Anticholinergic Burden Calculator at https://www.acbcalc.com.

Get a copy of the Anticholinergic Pocket Reference Card here: https://www.elderconsult.com/wp-content/uploads/AnticholinergicPocketReferenceCard-ECGM2018.jpg

Learn more about “Medication Overload and Older Americans at LownInstitute.org.