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Original Investigation
March 10, 2008

The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons

Author Affiliations

Author Affiliations: Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Healthcare System (Drs Rudolph, Salow, Angelini, and McGlinchey), Division of Aging, Department of Medicine, Brigham and Women's Hospital (Drs Rudolph and McGlinchey), Massachusetts College of Pharmacy (Dr Angelini), and Departments of Medicine (Dr Rudolph) and Psychiatry (Dr McGlinchey), Harvard Medical School, Boston.

Arch Intern Med. 2008;168(5):508-513. doi:10.1001/archinternmed.2007.106

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.