Table 3 Summary of study characteristics and validation of anticholinergic rating scales and its association with adverse outcomes in older people
Rating scales | Validation | |||||
|---|---|---|---|---|---|---|
Study design | Study population/setting | Study duration | Adverse outcome(s) studied | Significant association | Critical appraisal | |
Carnahan USA, 2006 (ADS) | Cross-sectional [9] | Long-term care residents (mean age 86), N = 279 | 1 month | SAA | + | Good |
|  | RCT [39] | Nursing home residents (mean age 85), N = 64 | 11 months | Cognitive function | – | Good |
|  | Cross-sectional [40] | Nursing home residents (mean age 73), N = 87 | 1 year | Cognitive function (MMSE) | – | Good |
Functional outcome (ADL) | – | |||||
|  | Cross-sectional [41] | Community-dwelling (aged ≥75), N = 621 | 3 years | Adverse events | + | Fair |
Cognitive function (MMSE, GDP) | + | |||||
Functional outcome (ADL, IADL) | + | |||||
|  | Longitudinal cohort [42] | Outpatient clinics (mean age 71.9 ± 7.3), N = 102 | 1 year | Cognitive function | + | Fair |
|  | Prospective cohort [43] | Hospital inpatients with hip fracture (aged ≥65), N = 364 | 48 hours to 5 days | Cognitive function (delirium) | – | Fair |
|  | Cross-sectional [44] | Hospital inpatients (mean age 67.9 ± 10.5), N = 450 | 28-30 days | Cognitive function | – | Fair |
|  | Cross-sectional [45] | Hospitalised (mean age 84 ± 6), N = 71 | 1 year | Mortality | – | Fair |
|  | Retrospective cohort [46] | Australian veterans (median age 80), N = 36015 | 2 years | Risk of hospitalisation for confusion or dementia | + | Good |
Han USA, 2008 (CrAS) | Prospective cohort [22] | Community-dwelling men (aged ≥65), N = 544 | 2 years | Cognitive function (Verbal recall test) | + | Good |
Functional outcome (ADL) | + | |||||
RCT [47] | Palliative care (mean aged 71), N = 461 | Mean survival was 8.9 weeks | Quality of life (McGill’s Quality of life index) | + | Fair | |
Functional outcome (Karnofsky performance scale) | + | |||||
Prospective cohort [48] | Veteran home demented residents (mean age 83.4), N = 53 | 12 weeks | Cognitive function (MMSE) | – | Fair | |
Functional outcome (BI) | – | |||||
Rudolph, USA 2008 (ARS) | Retrospective and prospective cohort (one each) [19] | Hospital and long-term care facilities (aged ≥65), N = 132 and N = 117 | 9 months | Central adverse effects (Confusion, dizziness, falls) | + | Good |
10 months | ||||||
Prospective cohort [15] | Hospital and long-term care (mean age 81.3), N = 1004 | 1 year | Mortality | – | Good | |
Prospective cohort [29] | Hospitalised patients (mean age 83.6 ± 6.6), N = 362 | 5 months | Physical function (BI) | – | Good | |
Mortality | – | |||||
LOS | – | |||||
Cohort study [49] | Hospitalised patients (mean age 83.6 ± 6.6), N = 362 | 5 months | Institutionalisation and comorbidities | + | Fair | |
Cohort study [50] | Hospital rehabilitation unit (mean age 79 ± 7), N = 117 | 9 months | Functional outcome (BI) | + | Fair | |
LOS | – | |||||
Cross-sectional [41] | Community-dwelling (aged ≥75), N = 621 | 3 years | Adverse events | + | Fair | |
Cognitive function (MMSE, GDP) | + | |||||
Functional outcome (ADL, IADL) | + | |||||
Cross-sectional prospective [27] | Hospital (aged ≥65), N = 1380 | 3 months | Cognitive function (SBT) | + | Good | |
Physical function (BI) | + | |||||
Longitudinal cohort [42] | Outpatient clinics (mean age 71.9 ± 7.3), N = 102 | 1 year | Cognitive function | + | Fair | |
Cross-sectional [45] | Hospitalised (mean age 84 ± 6), N = 71 | 1 year | Mortality | + | Good | |
Retrospective cohort [51] | National Health Insurance Research Database (aged ≥65), N = 54,888 | 1 year and 6 months | Emergency visit | + | Poor | |
Hospitalisation | + | |||||
Constipation | + | |||||
Delirium | + | |||||
Cardiac arrhythmia | + | |||||
Cognitive impairment | – | |||||
Retrospective cohort [46] | Australian veterans (median age 80), N = 36015 | 2 years | Risk of hospitalisation for confusion or dementia | + | Good | |
Boustani, USA 2008 (ACB) | Cross-sectional [52] | Nursing home patient with dementia (aged ≥66), N = 87 | 2 years and 2 months | Quality of life: Multiple engagement observations | – | Fair |
Longitudinal cohort [32] | Community-dwelling (aged ≥70), N = 1652 | 6 years | Cognitive function | + | Good | |
Observational cohort [53] | Hospitalised patients with cognitive impairment, N = 147 (aged ≥65) | Duration as of hospital admission | Cognitive function (Delirium using CAM) | – | Fair | |
Part of longitudinal cohort [54] | Nursing & residential homes, day hospital and inpatients with AD (mean age 81 ± 7.4), N = 224 | 1 year and 6 months | Cognitive function (MMSE and SIB) | – | Fair | |
Longitudinal cohort [33] | Community-dwelling and institutionalised patients (aged ≥65), N = 1304 | 2 years | Cognitive function | + | Good | |
Mortality | + | |||||
Retrospective cohort [34] | Primary-care clinics (aged ≥65), N = 3690 | 1 year | Cognitive function (MCI) | + | Fair | |
Prospective study [55] | Community-dwelling women (aged ≥75), N = 1429 | 5 years | Functional outcome (IADL) | + | Good | |
Cognitive function (MMSE) | – | |||||
Longitudinal cohort [56] | Community-dwelling women (aged ≥75), N = 1484 | 10 years | Cognitive function (MCI) | + | Good | |
Dementia | + | |||||
Cross-sectional prospective [27] | Hospital (aged ≥65), N = 1380 | 3 months | Cognitive function (SBT) | + | Good | |
Physical function (BI) | + | |||||
Cohort study [57] | Community-dwelling without dementia (aged ≥65), N = 896 | 10 years | Cognitive function | + | Fair | |
Retrospective study [58] | Hospital patients (aged ≥90), N = 419 | 3 months | Mortality | – | Fair | |
LOS | – | |||||
Longitudinal cohort [42] | Outpatient clinics (mean age 71.9 ± 7.3), N = 102 | 1 year | Cognitive function | + | Fair | |
|  | Cross-sectional [45] | Hospitalised (mean age 84 ± 6), N = 71 | 1 year | Mortality | – | Good |
Ehrt, Norway 2010 (AAS) | Longitudinal cohort [26] | Community-based PD patients (mean age 74.7), N = 78 | 8 years | Cognitive function (MMSE) | + | Good |
Sittironnarit Australia, 2011 (ACL) | Cross-sectional [23] | Subjects in 3 groups; healthy controls (N = 211), MCI (N = 768) and AD (N = 133) of mean age 70.0 ± 7.0, 75.7 ± 7.6, and 78.0 ± 8.6 years | 1 year and 10 months | Psychomotor speed and executive function | + | Good |