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Researchers developed the Anticholinergic Medication Index to help identify older people whose combination of medicines may put them at greater risk of falls or delirium. A clinical decision support version is live in two NHS trusts, while further pilots assess its use in hospital wards; whether wider use reduces these harms has not yet been established.
Researchers have developed a tool that scores older patients’ exposure to medicines with anticholinergic effects, helping NHS clinicians identify who may need a medication review to address potential falls and delirium risks. Its clinical decision support version is live in two NHS trusts, but the research does not establish that using it has reduced falls or delirium.
The Anticholinergic Medication Index, or ACMI, was developed by researchers at the University of Leeds, the University of Liverpool and Bradford Institute for Health Research. It scores a patient’s anticholinergic medication burden according to risks associated with delirium or falls. Anticholinergic effects can occur in drugs prescribed for different conditions, even when that effect is not their main purpose.
The team developed and tested the index using health records from nearly 750,000 adults over 65. Researchers used de-identified linked records from Connected West Yorkshire to develop the index, then tested it against a national dataset of patients in Wales held by the Secure Anonymized Information Linkage Databank. The findings were published in BMJ Medicine in 2026.
In a Bradford primary-care pilot, the tool automatically produced lists of patients aged 65 and older, their ACMI scores, the medicines contributing to those scores and their predicted one-year risk of a fall or delirium. Researchers say this can help clinicians and pharmacists prioritize structured medication reviews rather than calculating the information for each patient by hand.
A related clinical decision support system, called ACMICS, has been built into electronic patient records and is in use at two NHS trusts, according to the report. It recalculates scores when an anticholinergic medicine is started or stopped. The research team has also produced a technical specification intended to help other organizations develop an equivalent system.
How the tool could guide reviews
Many older patients take several medicines, and anticholinergic effects can accumulate across prescriptions. A score surfaced in an electronic record could give pharmacists and doctors a way to spot patients who merit a closer review, including people whose individual prescriptions may not appear high-risk when considered separately. The tool is designed to support clinical prioritization, not to replace clinicians’ decisions or automatically stop medicines.
Falls and delirium can have serious consequences for older people and add pressure and costs for the NHS. The researchers also identify other potential side effects of anticholinergic medicines, including constipation, difficulty emptying the bladder and dry mouth. However, a risk score is not proof that a medicine caused a particular problem, and a medication that has anticholinergic effects may still be the most suitable treatment for a patient.
The practical test is whether the system helps clinicians act safely within routine care. Embedding ACMICS in existing records may make the information more accessible than a separate calculator, but the published material describes implementation and ongoing pilots, not measured reductions in patient harm. The distinction matters: use in two trusts is evidence of deployment, not evidence that the tool has already cut falls or delirium.
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From risk research to NHS records
Anticholinergic medicines are used to treat a range of conditions, and their effects can also be present in medicines prescribed for other reasons. Researchers describe the combined exposure to these effects as anticholinergic burden. The report cites research linking that burden with delirium, falls and dementia, particularly among older people; it does not say that every person taking such medicines will experience these outcomes.
First author Dr. Kate Best, an associate professor of applied statistics at the University of Leeds, said about 50% of older adults in the UK are prescribed at least one anticholinergic medicine each year. She said the burden can accumulate and that the index may flag when a medication review is appropriate. That figure refers to annual prescribing of at least one such medicine, not to the share who experience a fall or delirium.
The study’s development and external validation used large datasets, while deployment involved a separate implementation effort. Researchers led by Dr. Aseel Abuzour and Andy Clegg embedded the system in hospital records at two NHS trusts. Their team is now piloting the tool in several geriatric medicine and orthopedic hip-fracture wards to examine whether wider use in secondary care is feasible.
“Approximately 50% of older adults are prescribed at least one anticholinergic medication annually in the U.K.”
— Dr. Kate Best, first author and associate professor of applied statistics at the University of Leeds
What outcome evidence is missing
The report does not provide results showing whether ACMI-guided reviews have reduced the number of falls, cases of delirium, hospital admissions or other harms. It also does not state how many patients have been assessed through the two trusts’ systems, how often scores lead to a medication change, or how clinicians and patients have experienced the process. Clinical benefit at scale remains unconfirmed.
It is also unclear from the available material when other NHS organizations might adopt the system, what resources implementation would require, or whether the same technical approach can be used across different electronic patient record systems. A high score signals a need for consideration, not a diagnosis or proof that medicines caused harm; treatment choices must account for each patient’s conditions and needs.
Hospital pilots will test feasibility
Researchers are piloting ACMI in several geriatric medicine and orthopedic hip-fracture wards to examine the feasibility of broader use in secondary care. The published report does not give an end date or say when results from those pilots will be available.
The team’s technical specification could help other health organizations build an equivalent system into their own records. Further reporting would need to establish the reach of implementation and, most importantly, whether medication reviews prompted by the tool improve patient outcomes without disrupting necessary treatment. For now, the confirmed development is that the index has moved from research into use at two trusts, while its effect on falls and delirium remains to be measured.
Key Questions
What is the Anticholinergic Medication Index?
The ACMI is a score designed to assess an older patient’s burden of medicines with anticholinergic effects, with the aim of helping clinicians identify patients who may need a medication review.
Is the tool already being used in the NHS?
Yes. A clinical decision support version, ACMICS, is reported to be live in two NHS trusts and embedded in their electronic patient record systems. Further hospital ward pilots are under way.
Has the tool been shown to prevent falls or delirium?
The report does not provide evidence that its use has reduced falls or delirium. Those outcomes remain unconfirmed; current work includes pilots examining feasibility of wider hospital use.
Does a high score mean a patient should stop a medicine?
No. The score is intended to help prioritize a clinical review, not make treatment decisions on its own. Some medicines with anticholinergic effects may still be the most appropriate option for an individual patient.
Source: medicalxpress.com
