Abstract
Objectives
This systematic review (PROSPERO CRD42019115918) compared the evidence behind anticholinergic
burden (ACB) measures and their ability to predict changes in older people's physical
function and quality of life.
Design
Eligible cohort or case-control studies were identified systematically using comprehensive
search terms and a validated search filter for prognostic studies. Medline (OVID),
EMBASE (OVID), CINAHL (EMBSCO), and PsycINFO (OVID) databases were searched. Risk
of bias, using Quality in Prognosis Studies tool, and quality of evidence, using the
Grading of Recommendations, Assessment, Development and Evaluation, were assessed.
Setting and Participants
People aged 65 years and older from any clinical setting.
Measures
Any ACB measures were accepted (including the anticholinergic domain of the Drug Burden
Index). Any global/multidimensional measure for physical function and/or quality of
life was accepted for outcome.
Results
Thirteen studies reporting associations between ACB and physical function (n = 10)
or quality of life (n = 4) were included. Exposure measures included Anticholinergic
Cognitive Burden Scale, Anticholinergic Drug Scale, Anticholinergic Risk Scale, Clinician
Rated Anticholinergic Score, and the anticholinergic domain of the Drug Burden Index.
All studies were rated moderate risk of bias in ≥2 Quality in Prognosis Studies categories
with 5 rated high risk in ≥1 categories. Seven of 10 studies (5251 of 7569 participants)
reported significant decline in physical function with increased burden. All 4 studies
(2635 participants) reporting quality of life demonstrated similar association with
increased burden. High risk of biases and inadequate data reporting restricted analysis.
There was no evidence to support one measure being superior to another.
Conclusions and Implications
The evidence supports association between increased ACB and future impairments in
physical function and quality of life. No conclusion can be made regarding which ACB
measure has the best prognostic value. Well-designed longitudinal studies are required
to address this. Clinicians should be aware of patient's anticholinergic burden and
consider alternative medications where appropriate.
Keywords
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Article info
Publication history
Published online: July 21, 2020
Footnotes
This work was supported by The Dunhill Medical Trust (grant number RPGF1806/66). Our funder (Dunhill Medical Trust) had no role in the design, methods, data collection, analysis or preparation of this manuscript.
The authors declare no conflicts of interest.
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
