Associations between the anticholinergic risk scale score and physical function

potential implications for adverse outcomes in older hospitalized patients

Estelle Lowry, Richard J. Woodman, Roy Soiza, Arduino A. Mangoni

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)565-572
Number of pages8
JournalJournal of the American Medical Directors Association
Volume12
Issue number8
DOIs
Publication statusPublished - Oct 2011

Fingerprint

Cholinergic Antagonists
Hospital Mortality
Hyponatremia
Confidence Intervals
Length of Stay
Institutionalization
Grooming
Bandages
Geriatrics
Dementia
Comorbidity
Outpatients
Odds Ratio
Demography
Prospective Studies

Keywords

  • anticholinergic drugs
  • anticholinergic risk scale
  • Barthel Index
  • outcomes

Cite this

Associations between the anticholinergic risk scale score and physical function : potential implications for adverse outcomes in older hospitalized patients. / Lowry, Estelle; Woodman, Richard J.; Soiza, Roy; Mangoni, Arduino A.

In: Journal of the American Medical Directors Association, Vol. 12, No. 8, 10.2011, p. 565-572.

Research output: Contribution to journalArticle

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abstract = "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.",
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TY - JOUR

T1 - Associations between the anticholinergic risk scale score and physical function

T2 - potential implications for adverse outcomes in older hospitalized patients

AU - Lowry, Estelle

AU - Woodman, Richard J.

AU - Soiza, Roy

AU - Mangoni, Arduino A.

PY - 2011/10

Y1 - 2011/10

N2 - 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.

AB - 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.

KW - anticholinergic drugs

KW - anticholinergic risk scale

KW - Barthel Index

KW - outcomes

U2 - 10.1016/j.jamda.2011.03.006

DO - 10.1016/j.jamda.2011.03.006

M3 - Article

VL - 12

SP - 565

EP - 572

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

IS - 8

ER -