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Safe prescribing in cognitively vulnerable patients: the use of the anticholinergic effect on cognition (AEC) tool in older adult mental health services

  • Delia Bishara (a1) (a2), Charlotte Scott (a1), Robert Stewart (a1) (a2), David Taylor (a1) (a2), Daniel Harwood (a1), David Codling (a1), Christine Banwell (a1) and Justin Sauer (a1) (a2)...

Abstract

Aims and method

Medication with anticholinergic action is associated with potentially serious adverse effects in older people. We present an evaluation of a novel anticholinergic burden scale introduced into routine practice in older adult services in the South London and Maudsley (SLaM) NHS Foundation Trust. Our aim was to assess whether this tool improved the accurate identification of anticholinergic medication and guided safer prescribing in cognitively vulnerable older people.

Results

The introduction of the anticholinergic effect on cognition (AEC) tool into clinical practice led to an increase in the identification and reporting to general practitioners of anticholinergic medication from 11 to 85% of cases (P = 0.0015).

Clinical implications

Application of the AEC tool led to improved detection of anticholinergic medication and advice to primary care on when a medication review is necessary. This is an important step towards improving the safety of prescribing in this patient group.

Declaration of interest

SLaM NHS Foundation Trust owns both the app and IP for Medichec.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence to Delia Bishara (delia.bishara@slam.nhs.uk)

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Joint first authors.

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References

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1Carriere, I, Fourrier-Reglat, A, Dartigues, JF, Rouaud, O, Pasquier, F, Ritchie, K, et al. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study. Arch Intern Med 2009; 169: 1317–24.
2Jessen, F, Kaduszkiewicz, H, Daerr, M, Bickel, H, Pentzek, M, Riedel-Heller, S, et al. Anticholinergic drug use and risk for dementia: target for dementia prevention. Eur Arch Psychiatry Clin Neurosci 2010; 260(Suppl 2): S1115.
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4Gray, SL, Anderson, ML, Dublin, S, Hanlon, JT, Hubbard, R, Walker, R, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Internal Med 2015; 175: 401–7.
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7National Institute for Health and Care Excellence. Dementia: Assessment, Management and Support for People Living With Dementia and Their Carers. NICE, 2018 (https://www.nice.org.uk/guidance/ng97/resources/dementia-assessment-management-and-support-for-people-living-with-dementia-and-their-carers-pdf-1837760199109).
8NHS England. Dementia Diagnosis and Management. A Brief Pragmatic Resource for General Practitioners. NHS England, 2015 (https://www.england.nhs.uk/wp-content/uploads/2015/01/dementia-diag-mng-ab-pt.pdf).
9Boustani, M, Campbell, N, Munger, S, Maidment, I, Fox, C. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health 2008; 4: 311–20.
10Duran, CE, Azermai, M, Vander Stichele, RH. Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol 2013; 69: 1485–96.
11Bishara, D, Harwood, D, Sauer, J, Taylor, D. Anticholinergic effect on cognition (AEC) of drugs commonly used in older people. Int J Geriatr Psychiatry 2017; 32(6): 650–6.
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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Safe prescribing in cognitively vulnerable patients: the use of the anticholinergic effect on cognition (AEC) tool in older adult mental health services

  • Delia Bishara (a1) (a2), Charlotte Scott (a1), Robert Stewart (a1) (a2), David Taylor (a1) (a2), Daniel Harwood (a1), David Codling (a1), Christine Banwell (a1) and Justin Sauer (a1) (a2)...
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