Staff Awareness of Anti-Cholinergic Burden (ACB) - A Qualitative Cross-Sectional Study in a Tertiary Care Hospital

Abstract

Introduction and hypothesis Anticholinergics are commonly used for a variety of conditions including urinary incontinence. Many studies show the ill effects of anticholinergics on cognition resulting in increased morbidity and mortality. However, the interaction of anticholinergic medications and cumulative anti-cholinergic burden (ACB) of different medications are not well known in general population and amongst health care professionals. Our aim is to study the extent of current awareness of ACB amongst health care professionals which plays a crucial role in educating patients and avoiding these morbidities. Methods A single centre cross-sectional study of 50 health care professionals who participated voluntarily. A questionnaire was designed to assess the knowledge, beliefs and attitudes towards anticholinergic burden and participants were also asked to choose the ACB score for 17 commonly used medications. Results A total of 74% participants admitted to have no understanding of the term ACB, 48% participants prescribe anticholinergics in their daily role, 44% knew that cognition was adversely affected by anticholinergics, and 16% participants were aware of scoring system. Only 16% participants routinely counsel women of cognitive side effects when anticholinergics are started. 86% reported that they would avoid prescribing medications which might affect cognition if possible. If given choice as a patient, 94% would avoid these medications if they were informed of the specific side effects like impaired cognition, physical decline, falls, hospital admissions and increased mortality. Conclusion Anticholinergic burden (ACB) is a serious phenomenon associated with increased morbidity and mortality in the general population as well as elderly population. It is evident from this study that the knowledge and awareness of ACB in our health care staff are still lacking.

Polypharmacy and cumulative anticholinergic burden in older adults hospitalized with fall

“…Despite it being well proven and understood in the literature that ACB is linked to poorer outcomes for older patients, awareness appears to remain low in clinical environments. A study conducted in 2020 showed that there is a limited understanding of the potential harms of starting regular anticholinergic medications among clinical staff 18 . Therefore, the process of due pharmacovigilance remains to be embedded into clinical practice among the wider medical team who care for patients above the age of 65 years.…”

“…A study conducted in 2020 showed that there is a limited understanding of the potential harms of starting regular anticholinergic medications among clinical staff. 18 Therefore, the process of due pharmacovigilance remains to be embedded into clinical practice among the wider medical team who care for patients above the age of 65 years.…”

CRIDECO Anticholinergic Load Scale: An Updated Anticholinergic Burden Scale. Comparison with the ACB Scale in Spanish Individuals with Subjective Memory Complaints

“…Furthermore, concomitant use of several medications with anticholinergic action will further increase the likelihood of adverse events [20]. However, a recent survey of pharmacists revealed that 45% of them did not know that these drugs were a risk factor for dementia [65] and only 44% of healthcare professionals knew that cognition was adversely affected by anticholinergics [66].…”

Polypharmacotherapy and cumulative anticholinergic burden in older adults hospitalised with fall

“…A study conducted in 2020 showed that there is a limited understanding of the potential harms of starting regular anticholinergic medications among clinical staff. 18 Therefore, the process of due pharmacovigilance remains to be embedded into clinical practice amongst the wider medical team who care for patients above the age of 65.…”