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Cited by 835Pharmaceutical Practices and Patient OutcomesBalance, Gait, and Falls PreventionPharmacovigilance and Adverse Drug Reactions

The anticholinergic risk scale and anticholinergic adverse effects in older persons

Rudolph, James L.·2008·Archives of Internal Medicine
DOI 10.1001/archinternmed.2007.106
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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.

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  • Diphenhydramine, other sedative-hypnotics, and medications for anxiety (benzodiazepines) or urinary incontinence (antimuscarinic) are relatively contraindicated in elderly and cognitively vulnerable persons.

    “For example, diphenhydramine, often taken as an over-the-counter drug combination with acetaminophen for sleep and pain relief; other sedative-hypnotics; and medications for anxiety (eg, benzodiazepines) or urinary incontinence (antimuscarinic) are relatively contraindicated in elderly and cognitively vulnerable persons.44,58”

    From The Alzheimer’s Disease Clinical Spectrum (2019) · cites this paper as [58]

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Authors
Rudolph, J. L.
Affiliations
VA Boston Healthcare System (US)
Corresponding author
Rudolph, James L.
ORCID
Rudolph, James L.
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2008-03-10
Volume
168
Issue
5
Pages
508
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinternmed.2007.106
OpenAlex
W1984458220
Cited by
835
References
22
Citations by year
2026: 36 · 2025: 33 · 2024: 70 · 2023: 57 · 2022: 49 · 2021: 71 · 2020: 71 · 2019: 64 · 2018: 58 · 2017: 41 · 2016: 45 · 2015: 46 · 2014: 51 · 2013: 29 · 2012: 33
FWCI
10.70
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Public Health Service (R01 1405)
  • National Institute on Aging (K12AG000294)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Keywords
Anticholinergic Risk Scale, anticholinergic effects, older adults, geriatric evaluation and management, primary care, falls, delirium, cognitive impairment, polypharmacy, medication reconciliation
MeSH terms
Aged, Drug Utilization, Humans, Male, Primary Health Care, Prospective Studies, Retrospective Studies, United States, Veterans, Geriatric Assessment, Chi-Square Distribution, Poisson Distribution, Risk Assessment, Cholinergic Antagonists

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