Original Study
Associations Between the Anticholinergic Risk Scale Score and Physical Function: Potential Implications for Adverse Outcomes in Older Hospitalized Patients

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Objectives

The anticholinergic risk scale (ARS) score is associated with the number of anticholinergic side effects in older outpatients. We tested the hypothesis that high ARS scores are negatively associated with “global” parameters of physical function (Barthel Index, primary outcome) and predict length of stay and in-hospital mortality (secondary outcomes) in older hospitalized patients.

Design and Setting

Prospective study in 2 acute geriatric units.

Participants

Three hundred sixty-two consecutive patients (age 83.6 ± 6.6 years) admitted between February 1, 2010, and June 30, 2010.

Measurements

Clinical and demographic characteristics, Barthel Index, full medication exposure, and ARS score were recorded on admission. Data on length of stay and in-hospital mortality were obtained from electronic records.

Results

After adjustment for age, gender, dementia, institutionalization, Charlson Comorbidity Index, admission site, and number of nonanticholinergic drugs, a unit increase in ARS score was associated with a 29% reduction in the odds of being in a higher Barthel quartile than a lower quartile (odds ratio 0.71, 95% confidence interval [CI] 0.59–0.86, P = .001). The Barthel components mostly affected were bathing (P < .001), grooming (P < .001), dressing (P < .001), transfers (P =.005), mobility (P < .001), and stairs (P < .001). Higher ARS scores predicted in-hospital mortality among patients with hyponatremia (hazard ratio [HR] 3.66, 95% CI 1.70–7.89, P = .001) but not those without hyponatremia (HR 1.04, 95% CI 0.70–1.54, P = .86). The ARS score did not significantly predict length of stay (HR 1.02, 95% CI 0.88–1.17, P = .82).

Conclusion

High ARS scores are negatively associated with various components of the Barthel Index and predict in-hospital mortality in the presence of hyponatremia among older patients. The ARS score may be useful in the acute setting to improve risk stratification.

Section snippets

Study Population

We studied a consecutive series of older patients (older than 60 years) admitted to acute geriatric medicine beds within 2 hospital sites (Aberdeen Royal Infirmary and Woodend Hospital, NHS Grampian, Aberdeen, Scotland, UK) from February 1, 2010, to June 30, 2010. Both units operate a “needs-based” rather than an “age-based” policy of admission, with patients characterized by aging-related frailty and/or complexity due to multiple medical and/or social issues, rather than single-organ

Results

A total number of 362 patients were admitted in the 2 acute geriatric units during the study period. The demographic and clinical characteristics of the study population are described in Table 1. The frequency distributions of the ARS and the dose-adjusted ARS scores were markedly skewed because 65.7% of patients had a score of 0 (i.e., no drugs with anticholinergic effects) (Figure 1).

Discussion

The results of this study suggest that higher ARS scores, unadjusted and dose-adjusted, are independently associated with lower scores in several components of the Barthel Index in a consecutive series of older patients admitted in an acute geriatric medicine service. The magnitude of this association was similar to other established clinical determinants of reduced physical function. Higher ARS scores did not predict increased LOS but predicted in-hospital mortality in the presence of

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  • Cited by (0)

    The authors declare no conflicts of interest.

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