title: The effect of comprehensive geriatric assessment on anticholinergic exposure assessed by four ranked anticholinergic lists.
abstract: BACKGROUND
  Older people often use multiple drugs, and some of them have anticholinergic activity. Anticholinergic drugs may cause adverse reactions, and therefore their use should be limited. To identify anticholinergic load, several ranked lists with different drugs and scoring systems have been developed and used widely in research. We investigated, if a comprehensive geriatric assessment (CGA) decreased the anticholinergic drug score in a 4-year period. We used four different anticholinergic ranked lists to determine the anticholinergic score and to describe how the results differ depending on the list used.
  
  
  METHODS
  We analyzed data from population-based intervention study, in which a random sample of 1000 persons aged ≥75 years were randomized to either an intervention group or a control group. Those in the intervention group underwent CGA including medication assessment annually between 2004 and 2007. Current medication use was assessed annually. The anticholinergic load was calculated by using four ranked lists of anticholinergic drugs (Boustani's, Carnahan's, Chew's and Rudolph's) for each person and for each year.
  
  
  RESULTS
  CGA had no statistically significant effect on anticholinergic exposure during the 4-year follow-up, but improvements towards more appropriate medication use were observed especially in the intervention group. However, age, gender and functional comorbidity index were associated to higher anticholinergic exposure, depending on the list used.
  
  
  CONCLUSIONS
  Repeated CGAs may result as more appropriate anticholinergic medication use. The selection of the list may affect the results and therefore the selection of the list is important.
authors.affiliation: Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Finland. Electronic address: Pasi.Lampela@uef.fi.
authors.forename: Pasi
authors.initials: P
authors.lastname: Lampela
authors.affiliation: Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Finland; Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Finland.
authors.forename: Heidi
authors.initials: H
authors.lastname: Taipale
authors.affiliation: Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Finland.
authors.forename: Piia
authors.initials: P
authors.lastname: Lavikainen
authors.affiliation: Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Finland.
authors.forename: Sirpa
authors.initials: S
authors.lastname: Hartikainen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D057187:Independent Living; D008297:Male; D017063:Outcome Assessment, Health Care
chemical_list: D018680:Cholinergic Antagonists
keywords: Anticholinergic drugs; Comprehensive geriatric assessment; Older people