Évaluation de la charge anticholinergique en gériatrie à l'aide de 3 échelles

Drugs with anticholinergic properties are responsible for many side effects such as falls, urinary retention or confusion. In recent years, various clinical scales have been developed, listed from 1 (mild) to 3 (severe) to assess the anticholinergic load of different drugs used in geriatrics. The aim of our study was to analyze the use of these drugs in geriatrics and to compare the results obtained with the three existing scales: the Anticholinergic Drug Scale (ADS), the Anticholinergic Cognitive Burden (ACB) and the Anticholinergic Risk Scale (ARS). This is a survey of a given day of prescriptions in all geriatric services at the Paul-Brousse Hospital in Villejuif (AP-HP). All patients aged over 65 were included. Out of the 441 patients hospitalized on the day of the study, 30.1% were taking at least one anticholinergic drug on the ARS scale, 52.8% according to the ADS scale and 55.3% according to the ARS. Regarding the anticholinergic load, 5.6% had a score ≥ 3 on the ARS scale, 12.3% on the ADS scale and 14% on the ACB scale. This confirms the disparities that exist between these three scales, especially in the classification of certain molecules such as ranitidine or paroxetine, and the presence or absence of other molecules, which strongly modifies the final score. In conclusion, anticholinergic scales in view of their limits have very little space in practice and should not replace clinical judgment. Geriatricians should be familiar with the group 3 drugs that should be avoided as much as possible.