Chief Investigator: Dr Kinda Ibrahim Associate Professor, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton

Team: Dr Stephen Lim, Principal Clinical Research Fellow, Honorary Consultant Geriatrician, Academic Geriatric Medicine, University Hospital Southampton.

 Dr Eloise Radcliffe, Senior Research Fellow, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton

Dr Emily Smith, Research Fellow, Pharmacy, University Hospital Southampton

Dr Cathrine McKenzie, Pharmacy and Critical Care, University Hospital Southampton

Mr Andrew Bates, Critical Care Nurse, Research Manager and NIHR Clinical Doctoral Research Fellow, University Hospital Southampton.

Dr Andy Fox, Consultant Pharmacist Medicines Safety, University Hospital Southampton, Southampton General Hospital

Dr Sara Mckelvie, Clinical lecturer, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton.

Mr Edward Hewertson, Geriatric consultant, Medicine for Older People, University Hospital Southampton, Southampton, General Hospital

Prof Tracey Sach, Professor in Health Economics, Faculty of Medicine, University of Southampton

Mrs Sarah Bennett, Medicine for Older People Lead Pharmacist, Pharmacy Department, University Hospital Southampton, Southampton General Hospital

Mr Kenny Fraser, co-founder of TRISCRIBE.

Mrs Pam Holloway and Mr Neil Wilson (Patient representatives)

Start: 1 October 2024

Duration: 31 March 2026

Partners: University Hospital Southampton NHS Foundation Trust, Triscribe Limited, Health Innovation Wessex.

Why this research is important?

It is estimated that over one third of all older adults are prescribed medication which are known to have “anticholinergic” side effects. These anticholinergic side effects can include an increased risk of falls, delirium, and memory problems. People who have a high number of anticholinergic medications have an increased risk of these side effects. This can be measured as their anticholinergic burden (ACB). Several tools have been developed to assess the ACB score, by checking a person’s medication list, with the aim of reducing these medications where possible (deprescribing).

The study aim

The project team worked with a company to design an online tool which can calculate the total ACB score for patients using their electronic medication list. It can also list the individual anticholinergic medications contributing to that score. Patients with high ACB score will be highlighted to healthcare staff including pharmacists, nurses, and doctors. In this project, we plan to understand how this tool can be used by clinicians in older persons wards to reduce the number of anticholinergic medications prescribed where appropriate.

Our approach

Working with doctors and pharmacists in one large hospital, we agreed how the tool should be used. First, pharmacists with check weekly using the digital tool how many patients have high ACB scores. Then they would highlight in patients’ medical notes the list of medications with high anticholinergic effects using a sticker note. The doctor looking after the patient then sees the note which would prompt him/her to either stop the drug, reduce the dose or switch to a safer drug.

We will test this intervention among 50 patients admitted to older people wards. We will collect information before and after receiving the intervention including number and type of medications prescribed, quality of life, and cognition. We will also talk to staff and patients to understand their views about the intervention, any challenges, and how to improve the process.

Involving patients and public

Two patient and public contributors have been actively involved in developing this research proposal. They represent an older person with comorbidity and polypharmacy and a carer, and both have lived experience of managing polypharmacy following hospital admission. They will continue to provide input on study procedures and materials and contribute to plans for sharing the findings.

Sharing the study findings

We will share the findings with public, health professionals, researchers and policymakers through plain

English summaries, social media, policy briefing documents, scientific papers, conferences and other meetings.