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Anticholinergic Drug Burden Tools/Scales and Adverse Outcomes in Different Clinical Settings: A Systematic Review of Reviews

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Abstract

Background

Cumulative anticholinergic exposure (anticholinergic burden) has been linked to a number of adverse outcomes. To conduct research in this area, an agreed approach to describing anticholinergic burden is needed.

Objective

This review set out to identify anticholinergic burden scales, to describe their rationale, the settings in which they have been used and the outcomes associated with them.

Methods

A search was performed using the Healthcare Databases Advanced Search of MEDLINE, EMBASE, Cochrane, CINAHL and PsycINFO from inception to October 2016 to identify systematic reviews describing anticholinergic burden scales or tools. Abstracts and titles were reviewed to determine eligibility for review with eligible articles read in full. The final selection of reviews was critically appraised using the ROBIS tool and pre-defined data were extracted; the primary data of interest were the anticholinergic burden scales or tools used.

Results

Five reviews were identified for analysis containing a total of 62 original articles. Eighteen anticholinergic burden scales or tools were identified with variation in their derivation, content and how they quantified the anticholinergic activity of medications. The Drug Burden Index was the most commonly used scale or tool in community and database studies, while the Anticholinergic Risk Scale was used more frequently in care homes and hospital settings. The association between anticholinergic burden and clinical outcomes varied by index and study. Falls and hospitalisation were consistently found to be associated with anticholinergic burden. Mortality, delirium, physical function and cognition were not consistently associated.

Conclusions

Anticholinergic burden scales vary in their rationale, use and association with outcomes. This review showed that the concept of anticholinergic burden has been variably defined and inconsistently described using a number of indices with different content and scoring. The association between adverse outcomes and anticholinergic burden varies between scores and has not been conclusively established.

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Authors and Affiliations

  1. Research Institute for the Care of Older People (RICE), Royal United Hospital, Combe Park, Bath, BA1 3NG, UK

    Tomas J. Welsh

  2. Royal United Hospital Bath NHS Foundation Trust, Bath, Somerset, UK

    Tomas J. Welsh

  3. University of Nottingham, Nottingham, Nottinghamshire, UK

    Veronika van der Wardt, Grace Ojo, Adam L. Gordon & John R. F. Gladman

  4. Derby Teaching Hospitals NHS Foundation Trust, Derby, Derbyshire, UK

    Adam L. Gordon

  5. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Leicester, UK

    John R. F. Gladman

  6. University of Bristol, Bristol, UK

    Tomas J. Welsh

  7. NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, UK

    John R. F. Gladman

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  1. Tomas J. Welsh
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Correspondence to Tomas J. Welsh.

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Tomas Welsh, Veronika Van der Wardt, Grace Ojo, Adam Gordon and John Gladman have no conflicts of interest directly relevant to the content of this review.

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Welsh, T.J., van der Wardt, V., Ojo, G. et al. Anticholinergic Drug Burden Tools/Scales and Adverse Outcomes in Different Clinical Settings: A Systematic Review of Reviews. Drugs Aging 35, 523–538 (2018). https://doi.org/10.1007/s40266-018-0549-z

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