Evaluating the Anticholinergic Burden in Older Patients: Comprehensive Insights from a Nationwide Survey Among Emergency Medicine Specialists in the UK

Introduction Older patients are often exposed to medications with anticholinergic activity. Anticholinergic burden (ACB) from medicines is linked to adverse health outcomes. However, healthcare professionals’ familiarity with ACB remains poor, and there is a lack of literature in knowledge, attitudes, or practices (KAP) of ACB among Emergency department (ED) clinicians. Methods A nationwide survey of ACB (using https://www.acbcalc.com) based on a pilot survey was developed using the KAP framework and assessed for face and content validity by ACB experts. It was distributed to ED physicians across the UK using REDCap through social media and professional networks. Results Among the 108 ED physicians who responded, 54.6% (n=59) were aware of the term ACB, but 54.2% (n=32/59) of them were unable to describe it. Their mean scores for quantifying the ACB score and identifying side effects in older patients were 2.9 and 4.1 out of 10, respectively. 88.9% (n=96) believed that ACB is an important consideration in older patients. 67.6% (n=73) agreed that awareness of the consequences of prescribing anticholinergic medications to older patients is important. 50% (n=54) emphasized the importance of being able to assess and quantify the ACB score. Of the 75 physicians who prescribed these medications, 40% (n=30/75) were unaware of ACB. 38.7% (n=29/75) rarely considered ACB, 30.7% (n=23/75) never considered it, and only 1.3% (n=1/75) always considered it. The majority of respondents (88.9%, n=96) agreed that more education on ACB is needed in the ED. Conclusion ED physicians in the UK have limited knowledge and awareness of ACB management and prescribing practices for older patients. However, they show positive attitudes towards their role in ACB management and a willingness to receive further education.