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The anticholinergic risk scale and anticholinergic adverse effects in older persons.
Arch Intern Med. 2008 Mar 10; 168(5):508-13.AI

Abstract

BACKGROUND

Adverse effects of anticholinergic medications may contribute to events such as falls, delirium, and cognitive impairment in older patients. To further assess this risk, we developed the Anticholinergic Risk Scale (ARS), a ranked categorical list of commonly prescribed medications with anticholinergic potential. The objective of this study was to determine if the ARS score could be used to predict the risk of anticholinergic adverse effects in a geriatric evaluation and management (GEM) cohort and in a primary care cohort.

METHODS

Medical records of 132 GEM patients were reviewed retrospectively for medications included on the ARS and their resultant possible anticholinergic adverse effects. Prospectively, we enrolled 117 patients, 65 years or older, in primary care clinics; performed medication reconciliation; and asked about anticholinergic adverse effects. The relationship between the ARS score and the risk of anticholinergic adverse effects was assessed using Poisson regression analysis.

RESULTS

Higher ARS scores were associated with increased risk of anticholinergic adverse effects in the GEM cohort (crude relative risk [RR], 1.5; 95% confidence interval [CI], 1.3-1.8) and in the primary care cohort (crude RR, 1.9; 95% CI, 1.5-2.4). After adjustment for age and the number of medications, higher ARS scores increased the risk of anticholinergic adverse effects in the GEM cohort (adjusted RR, 1.3; 95% CI, 1.1-1.6; c statistic, 0.74) and in the primary care cohort (adjusted RR, 1.9; 95% CI, 1.5-2.5; c statistic, 0.77).

CONCLUSION

Higher ARS scores are associated with statistically significantly increased risk of anticholinergic adverse effects in older patients.

Authors+Show Affiliations

Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA. jrudolph@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

18332297

Citation

Rudolph, James L., et al. "The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons." Archives of Internal Medicine, vol. 168, no. 5, 2008, pp. 508-13.
Rudolph JL, Salow MJ, Angelini MC, et al. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168(5):508-13.
Rudolph, J. L., Salow, M. J., Angelini, M. C., & McGlinchey, R. E. (2008). The anticholinergic risk scale and anticholinergic adverse effects in older persons. Archives of Internal Medicine, 168(5), 508-13. https://doi.org/10.1001/archinternmed.2007.106
Rudolph JL, et al. The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons. Arch Intern Med. 2008 Mar 10;168(5):508-13. PubMed PMID: 18332297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The anticholinergic risk scale and anticholinergic adverse effects in older persons. AU - Rudolph,James L, AU - Salow,Marci J, AU - Angelini,Michael C, AU - McGlinchey,Regina E, PY - 2008/3/12/pubmed PY - 2008/4/11/medline PY - 2008/3/12/entrez SP - 508 EP - 13 JF - Archives of internal medicine JO - Arch Intern Med VL - 168 IS - 5 N2 - BACKGROUND: Adverse effects of anticholinergic medications may contribute to events such as falls, delirium, and cognitive impairment in older patients. To further assess this risk, we developed the Anticholinergic Risk Scale (ARS), a ranked categorical list of commonly prescribed medications with anticholinergic potential. The objective of this study was to determine if the ARS score could be used to predict the risk of anticholinergic adverse effects in a geriatric evaluation and management (GEM) cohort and in a primary care cohort. METHODS: Medical records of 132 GEM patients were reviewed retrospectively for medications included on the ARS and their resultant possible anticholinergic adverse effects. Prospectively, we enrolled 117 patients, 65 years or older, in primary care clinics; performed medication reconciliation; and asked about anticholinergic adverse effects. The relationship between the ARS score and the risk of anticholinergic adverse effects was assessed using Poisson regression analysis. RESULTS: Higher ARS scores were associated with increased risk of anticholinergic adverse effects in the GEM cohort (crude relative risk [RR], 1.5; 95% confidence interval [CI], 1.3-1.8) and in the primary care cohort (crude RR, 1.9; 95% CI, 1.5-2.4). After adjustment for age and the number of medications, higher ARS scores increased the risk of anticholinergic adverse effects in the GEM cohort (adjusted RR, 1.3; 95% CI, 1.1-1.6; c statistic, 0.74) and in the primary care cohort (adjusted RR, 1.9; 95% CI, 1.5-2.5; c statistic, 0.77). CONCLUSION: Higher ARS scores are associated with statistically significantly increased risk of anticholinergic adverse effects in older patients. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/18332297/The_anticholinergic_risk_scale_and_anticholinergic_adverse_effects_in_older_persons_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinternmed.2007.106 DB - PRIME DP - Unbound Medicine ER -