Employing Shared Decision Making (SDM) to reduce the Anti-Cholinergic Burden (ACB)

Abstract Background Anticholinergic medicines can cause a range of adverse drug reactions (ADRs) including urinary retention, dry mouth, constipation, tachycardia, blurred vision, sedation, dizziness, confusion and delirium. 10% of hospital admissions in those 65 years of age are Adverse Drg Reaction (ADR) related, and approximately 70% of these can be avoided. Shared decision making (SDM) is a joint process in which a healthcare professional works with a person to reach a decision about their care. Medicines should be deprescribed, if a shared decision is reached that the risks outweigh the benefits for the individual. Methods Results Thirty-eight patients, with a mean age of 76 years received a medication review. The mean number of regular medicines pre-review was 10.5 and post review was 9.3. The mean ACB score pre-review was 5.4 and post review was 3.5. An ACB reduction was achieved in 25 patients (66%) patients. The total ACB score reduction achieved was 73. 90% of the total reduction was achieved by stopping urinary antispasmodics, amitriptyline, quetiapine, promethazine and lansoprazole. Conclusion Targeting future SDM interventions to patients on those anticholinergic medicines found to be amenable to deprescribing might be an efficient way to reduce anticholinergic burden and harm.