Applicability of Anticholinergic Risk Scale in hospitalized elderly persons

Abstract

Objective: to define the applicability of the Anticholinergic Risk Scale (ARS) as a risk indicator of delirium in hospitalized elderly persons. Method: the medical records of elderly patients hospitalized in the medical wards of a teaching hospital were analyzed with the ARS, translated and adapted for medicines used in Brazil. The version of the Confusion Assessment Method (CAM) for the clinical diagnosis of delirium translated and validated by Fabbri et al. was used. Individuals aged ≥60 years were included in the evaluation of drug use. The sample was divided by gender and age to analyze the effect of these variables on the use of anticholinergic drugs based on the ARS, and association with delirium. Results: 123 elderly persons, 47 men and 76 women, with a mean age of 72.7(±9.2) years were included. The average consumption of drugs not listed in the ARS (some with anticholinergic action as Ipratropium and Scopolamine) was 6.1(±3.0) and the average number of drugs used listed in the ARS (Metoclopramide, Ranitidine, Atropine, Haloperidol and Risperidone) was 0.9±0.6. Four elderly persons had a score ≥3 (3.3% of total cases). Delirium was observed in 27 patients (21.9% of the total), none of whom scored more than two ARS points. There was no statistical significance regarding gender, age and delirium. Conclusion: the average score of the ARS was low among this population, and did not correlate with delirium. The ARS does not cover all anticholinergics, meaning this study should be repeated in a geriatric ward for comparison.

O uso de fármacos anticolinérgicos e fatores associados em adultos de meia-idade e idosos

“…A variável dependente do estudo foi a carga anticolinérgica (CAC), determinada pela American Drug Scale (ADS). Essa escala provém de estudo norte-americano que analisou a ação anticolinérgica de mais de 500 fármacos, realizando validação sérica por meio de um ensaio clínico 18 . Um modelo matemático permitiu estimar a carga exercida por essas drogas, das quais 117 mostraram exercer algum efeito anticolinérgico.…”

“…Embora diversos estudos tenham se ocupado de investigar o tema, em especial no âmbito internacional, poucos incluem populações mais jovens, como os adultos de meia-idade 16,17 . No Brasil, foi encontrado apenas um estudo com essa temática, restrito a idosos hospitalizados 18 . Assim, o presente estudo tem por objetivo analisar o uso de medicamentos anticolinérgicos e fatores associados em indivíduos de meia-idade e idosos.…”