Background: Anticholinergic medications are among the most widely prescribed drug classes in older adults, yet their cumulative burden poses substantial risks for cognitive decline, falls, and functional impairment. The Anticholinergic Cognitive Burden (ACB) scale provides a validated framework for quantifying this risk, with scores ≥3 indicating clinically significant burden. Objective: This quality improvement project (QIP) aimed to identify patients aged ≥65 years with an ACB score ≥3 in a primary care setting and to implement structured medication review interventions, including de-prescribing, switching, or dose adjustment, to reduce anticholinergic burden. Methods: A cross-sectional quality improvement design was employed over a six-month period (January–June 2024) in a GP practice in the United Kingdom. All registered patients aged ≥65 years were systematically screened using the ACB scale. Patients with a total ACB score ≥3 underwent structured medication reviews. Interventions included de-prescribing, therapeutic switching to alternatives with lower anticholinergic activity, and dose reduction. Pre- and post-intervention ACB scores were compared. Results: Of 120 patients screened, 98 were aged ≥65 years and 62 (63.3%) had an ACB score ≥3. The most prevalent anticholinergic agents were amitriptyline (29.0%), oxybutynin (22.6%), and tolterodine (19.4%). Following intervention, the mean ACB score decreased from 4.7 ± 1.1 to 2.9 ± 1.0 (p<0.001), the proportion of patients with ACB ≥3 reduced from 63.3% to 42.9%, and Mini-Mental State Examination scores showed modest improvement. Conclusion: Structured, ACB-guided medication reviews in older primary care patients are feasible and effective in reducing anticholinergic burden. Embedding systematic pharmacological review within routine geriatric care can meaningfully protect cognitive function and reduce fall risk in this vulnerable population.