title: Associations between the anticholinergic risk scale score and physical function: potential implications for adverse outcomes in older hospitalized patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective study in 2 acute geriatric units.
  
  
  METHODS
  Three hundred sixty-two consecutive patients (age 83.6 ± 6.6 years) admitted between February 1, 2010, and June 30, 2010.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Estelle
authors.initials: E
authors.lastname: Lowry
authors.affiliation: Discipline of General Practice, School of Medicine, Flinders University, Adelaide, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Woodman
authors.affiliation: Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom; Department of Medicine for the Elderly, Woodend Hospital, NHS Grampian, Aberdeen, United Kingdom.
authors.forename: Roy L
authors.initials: RL
authors.lastname: Soiza
authors.affiliation: Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom; Department of Medicine for the Elderly, Woodend Hospital, NHS Grampian, Aberdeen, United Kingdom. Electronic address: a.a.mangoni@abdn.ac.uk.
authors.forename: Arduino A
authors.initials: AA
authors.lastname: Mangoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005851:Geriatric Nursing; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D051346:Mobility Limitation; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D018570:Risk Assessment; D012606:Scotland
chemical_list: D018680:Cholinergic Antagonists