Díaz-Acedo Rocío, Villalba-Moreno Ángela María, Santos-Ramos Bernardo, Sánchez-Fidalgo Susana
Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot S/N, CP 41013, Sevilla, Spain.
Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot S/N, CP 41013, Sevilla, Spain.
Res Social Adm Pharm. 2025 Mar;21(3):117-133. doi: 10.1016/j.sapharm.2024.12.004. Epub 2024 Dec 13.
The rising prevalence of chronic conditions and polypharmacy in the elderly increases the risk of anticholinergic burden, the cumulative effect of multiple anticholinergic drugs. However, no standard exists for assessing anticholinergic burden in these patients, resulting in various anticholinergic scales with differing methodologies and outcomes.
To identify existing anticholinergic scales that are applicable to elderly chronic patients and to compare their main characteristics, included drugs and anticholinergic potential scores. In addition, we aim to analyse the previous validation of these scales.
We conducted a systematic review (MEDLINE, EMBASE and Web of Science; PROSPERO ID CRD42024505226; October 2023) for studies on anticholinergic scales applicable to elderly patients with chronic conditions. We also examined the validation of these tools in predicting anticholinergic-related adverse outcomes. Inclusion criteria targeted studies on anticholinergic scales for patients aged ≥65 with chronic conditions, excluding those hospitalized or with specific diseases. Quality assessments utilized JBI tools and SQUIRE 2.0 standards.
From 1399 references, 18 anticholinergic scales development studies were included. Different scales varied in creation methodology, with some based on literature, review of previous scales or experimental data. The included studies are heterogeneous in terms of design and results of their quality analysis. For the second objective, 29 validation studies were considered, with mixed associations found between anticholinergic scales and health outcomes.
Current anticholinergic scales and validation studies are diverse and show mixed and controversial results, with evidence often coming from retrospective or low-quality studies; indicating the necessity for future research to focus on developing a clinically applicable tool for accurately assessing anticholinergic burden in the elderly with chronic conditions.
老年人慢性病患病率上升以及多种药物联合使用增加了抗胆碱能负担的风险，即多种抗胆碱能药物的累积效应。然而，目前尚无评估这些患者抗胆碱能负担的标准，导致出现了各种方法和结果各异的抗胆碱能量表。
识别适用于老年慢性病患者的现有抗胆碱能量表，并比较它们的主要特征，包括所涵盖的药物和抗胆碱能潜力评分。此外，我们旨在分析这些量表先前的验证情况。
我们进行了一项系统综述（检索MEDLINE、EMBASE和Web of Science；PROSPERO注册号CRD42024505226；2023年10月），以查找适用于老年慢性病患者的抗胆碱能量表的研究。我们还研究了这些工具在预测抗胆碱能相关不良结局方面的验证情况。纳入标准针对年龄≥65岁的慢性病患者的抗胆碱能量表研究，排除住院患者或患有特定疾病的患者。质量评估采用JBI工具和SQUIRE 2.0标准。
从1399篇参考文献中，纳入了18项抗胆碱能量表开发研究。不同量表的创建方法各不相同，有些基于文献、对先前量表的回顾或实验数据。纳入研究在设计和质量分析结果方面存在异质性。对于第二个目标，考虑了29项验证研究，发现抗胆碱能量表与健康结局之间的关联不一。
目前的抗胆碱能量表和验证研究多种多样，结果好坏参半且存在争议，证据往往来自回顾性研究或低质量研究；这表明未来有必要开展研究，重点开发一种临床适用工具，以准确评估老年慢性病患者的抗胆碱能负担。
