Exploring the integration of anticholinergic burden scales into prehospital care

Background: The anticholinergic burden (ACB) from multiple medications can impair muscle activation, memory and learning – particularly in older individuals, leading to cognitive decline and falls. Managing ACB can improve health outcomes and reduce hospitalisation. This review evaluates the use of ACB scales in prehospital care. Objectives: By examining the existing evidence, this review will contribute to the ongoing discussion about the potential for the use of ACB scales as a routine part of paramedic practice. It will also explore the broader implications of implementing such tools, including the need for standardisation, potential challenges in the prehospital context, and the impact on patient care and healthcare systems. Methods: Adopting a scoping review framework, the review explores ACB scales' integration and effectiveness in prehospital care. The primary research question focuses on improving outcomes for older individuals and reducing hospital admissions. Initial screening of titles and abstracts were conducted by one reviewer. Full-text articles of potentially relevant studies were then assessed independently by two reviewers against the inclusion and exclusion criteria. Discrepancies were resolved through discussion to ensure consistency and rigour in the selection process. Results: Of the 756 articles identified, 12 were selected for final review. Findings indicate strong correlations between ACB scales and adverse events, with higher ACB scores linked to likelihood of increased hospitalisation. No causality was established. Conclusions: There is a need for a standardised ACB tool for use in prehospital care to help reduce service demand and improve patient outcomes.