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Researchers have developed the Anticholinergic Medication Index (ACMI), a tool that estimates older patients’ risk of falls or delirium associated with anticholinergic medicines. Its clinical decision-support version is in use at two NHS trusts, while pilots are under way to assess wider use. The research describes a way to identify patients for medication review; it does not report that the tool has reduced falls or delirium.
Researchers have developed a tool that helps clinicians identify people aged 65 and older who may be at higher risk of falls or delirium linked to multiple medicines with anticholinergic effects. The tool, called the Anticholinergic Medication Index (ACMI), has been tested using health records and its clinical decision-support version is now in use at two NHS trusts; whether its use reduces falls or delirium has not yet been established by the report.
The ACMI assigns a score based on anticholinergic medicines a patient takes and their association with delirium or falls. Anticholinergic effects can occur in medicines prescribed for different conditions, including when that effect is not the drug’s main purpose. Researchers say the effects can accumulate when a person takes several such medicines, a concern for older patients who may be treated for multiple conditions.
In a pilot at GP practices in Bradford, the system automatically produced lists of patients aged 65 or older, their ACMI scores, the medicines contributing to those scores and their predicted risk over one year of a fall or delirium. Without automated calculation, staff would have had to compile this information patient by patient before pharmacists could prioritize medication reviews.
A related clinical decision-support system, called ACMICS, is embedded in electronic patient records and is live in two NHS trusts. According to the research team, it appears at points in the clinical workflow and recalculates when an anticholinergic medicine is started or stopped. The researchers also produced a technical specification intended to help other organizations build an equivalent tool for their own records systems.
How the Tool Could Guide Reviews
The practical aim is to help clinicians spot patients who may merit a structured review of their medicines without first having to calculate each person’s exposure manually. That could make medication review more targeted in primary care and hospitals, where teams manage many patients and prescribing decisions can involve competing needs.
Researcher Kate Best said around 50% of older adults in the UK are prescribed at least one anticholinergic medicine annually. This figure describes prescribing prevalence, not the share who experience harm. The tool is intended to support review, not automatically stop treatment: an anticholinergic medicine may still be the best option for an individual patient.
Falls and delirium can have serious consequences for older people and can create additional demands on health services. The index may help clinicians bring medication risks into prescribing decisions, but the source material does not report measured reductions in either outcome or establish savings to the NHS.
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From Risk Evidence to NHS Records
The ACMI was developed and tested using health records for nearly 750,000 adults over 65. The researchers used de-identified routine care data from Connected West Yorkshire to develop the index, then tested it against a national dataset in Wales held by the Secure Anonymized Information Linkage (SAIL) Databank. The study, by Kate E. Best and colleagues, was published in BMJ Medicine in 2026.
The team includes researchers from the universities of Leeds and Liverpool and Bradford Institute for Health Research. Separate work embedded the clinical decision-support system in hospital records at two NHS trusts. Researchers say it was designed around observations of clinical practice and to operate within existing electronic records, rather than as a separate online calculator.
Identifying medicines with anticholinergic effects is not new; the implementation challenge, as Liverpool researcher Munir Pirmohamed described it, is turning known risks into routine clinical action. The ACMI’s contribution is an automated score and workflow prompt intended to help staff prioritize who may need review.
“Approximately 50% of older adults are prescribed at least one anticholinergic medication annually in the U.K.”
— Dr. Kate Best, associate professor of applied statistics at the University of Leeds and the study’s first author
Evidence on Patient Outcomes
The supplied report describes the index’s development, validation and implementation, but does not give results showing that it has reduced falls, delirium or dementia. Nor does it provide figures on how often the software changes prescribing, how many patients have received medication reviews, or whether those reviews improve outcomes. The one-year risk figures generated in the Bradford pilot are predictions, not observed proof that a particular patient will experience an event.
The report also does not name the two NHS trusts using ACMICS or provide details on the size and duration of that implementation. It remains unclear how readily the system can be adapted across different electronic patient record platforms and what resources wider deployment would require. A high score is a prompt for clinical consideration, not a finding that every listed medicine should be withdrawn.
Hospital Pilots and Wider Use
The research team is piloting ACMI in several geriatric medicine and orthopedic hip fracture wards to assess whether it is feasible to use more widely in secondary care. The source does not give a timetable for those pilots or say when results will be published.
The technical specification may help other health organizations develop comparable functions in their own electronic records. Further evidence would be needed to show whether wider adoption changes prescribing and, in turn, lowers rates of falls or delirium. For now, the confirmed development is an implemented decision-support tool at two trusts, alongside ongoing work to test broader use.
Key Questions
What does the ACMI tool do?
It scores a patient’s exposure to medicines with anticholinergic effects and estimates risk related to delirium or falls. Its purpose is to help clinicians identify people who may need a medication review.
Is the tool already being used in the NHS?
The clinical decision-support version, ACMICS, is reported to be live in two NHS trusts. The report does not identify those trusts by name.
Has the tool been shown to prevent falls or delirium?
The report describes development, testing and implementation, but does not provide evidence that using the tool has reduced falls or delirium. Further evaluation is needed to establish its effect on patient outcomes.
Does a high score mean a patient should stop a medicine?
No. The score is intended to help prioritize a clinical review; it is not an instruction to stop treatment. Researchers note that an anticholinergic medicine may still be the best treatment for some patients.
Source: medicalxpress.com
