The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons

TLDR

Adverse effects of anticholinergic medications may contribute to events such as falls, delirium, and cognitive impairment in older patients. The study aimed to determine whether the Anticholinergic Risk Scale (ARS) score could predict anticholinergic adverse effects in geriatric evaluation and management and primary care cohorts. Medical records of 132 GEM patients and prospective enrollment of 117 primary‑care patients aged ≥65 were reviewed, medication reconciliation performed, and Poisson regression used to assess the relationship between ARS scores and adverse effects. Higher ARS scores were associated with increased risk of anticholinergic adverse effects, with crude relative risks of 1.5 in GEM and 1.9 in primary care, and adjusted risks of 1.3 and 1.9 respectively, indicating a statistically significant association.

Abstract

<h3>Background</h3> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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;<i>c</i>statistic, 0.74) and in the primary care cohort (adjusted RR, 1.9; 95% CI, 1.5-2.5;<i>c</i>statistic, 0.77). <h3>Conclusion</h3> Higher ARS scores are associated with statistically significantly increased risk of anticholinergic adverse effects in older patients.