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Table 3 Summary of study characteristics and validation of anticholinergic rating scales and its association with adverse outcomes in older people

From: Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review

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
  1. SAA = Serum Anticholinergic Activity; ACE = Addenbrooke's Cognitive Examination; TMT = Trail Making Test; MMSE = Mini-Mental State Examination; CAM = Confusion Assessment Method; DSST = Digit Symbol Substitution Test; ADL = Activity of Daily Living; AD = Alzheimer’s Disease; IADL = Instrumental Activities of Daily Living; RCT = Randomised Controlled Trial; SIB = Severe Impairment Battery; SBT = Short Blessed Test; BI = Barthel Index; MCI = Mild Cognitive Impairment; PD = Parkinson’s Disease; LOS = Length of Stay; GDP = Geriatric Depression Scale; ADS = Anticholinergic Drug Scale; CrAS = Clinician-rated Anticholinergic Score; ARS = Anticholinergic Risk Scale; ACB = Anticholinergic Cognitive Burden Scale; AAS = Anticholinergic Activity Scale; ACL = Anticholinergic Loading Scale.