Development of the Japanese Anticholinergic Risk Scale: English translation of the Japanese article

Fumihiro Mizokami; Tomohiro Mizuno; Rena Taguchi; Izumi Nasu; Sayaka Arai; Keiichiro Higashi; Ayaka Matsumoto; Miwako Kamei; Taro Kojima; Takayoshi Sakai; Yuuka Shibata; Yasushi Takeya; Masaki Mogi; Shizuo Yamada; Masahiro Akishita; Japanese Society of Geriatric Pharmacy Working Group on Japanese Anticholinergic Risk Scale

doi:10.1111/ggi.15001

Development of the Japanese Anticholinergic Risk Scale: English translation of the Japanese article

Geriatr Gerontol Int. 2024 Dec 5. doi: 10.1111/ggi.15001. Online ahead of print.

Authors

Fumihiro Mizokami¹, Tomohiro Mizuno², Rena Taguchi³, Izumi Nasu⁴, Sayaka Arai⁵, Keiichiro Higashi⁶, Ayaka Matsumoto⁷, Miwako Kamei⁸, Taro Kojima⁹, Takayoshi Sakai¹⁰, Yuuka Shibata¹¹, Yasushi Takeya¹², Masaki Mogi¹³, Shizuo Yamada¹⁴, Masahiro Akishita¹⁵; Japanese Society of Geriatric Pharmacy Working Group on Japanese Anticholinergic Risk Scale

Affiliations

¹ Department of Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan.
² Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Toyoake, Japan.
³ Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.
⁴ Flatiron Health K.K., Tokyo, Japan.
⁵ Division of Pharmacy, Chiba University Hospital, Chiba, Japan.
⁶ Department of Pharmacy, Asanogawa General Hospital, Kanazawa, Japan.
⁷ Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
⁸ Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan.
⁹ Department of Geriatric Medicine, The University of Tokyo, Tokyo, Japan.
¹⁰ Department of Rehabilitation for Orofacial Disorders, Osaka University Graduate School of Dentistry, Osaka, Japan.
¹¹ Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Japan.
¹² Department of Geriatric Nursing, Osaka University Graduate School of Medicine, Osaka, Japan.
¹³ Department of Pharmacology, Ehime University Graduate School of Medicine, Matsuyama, Japan.
¹⁴ Center for Pharma-Food Research (CPFR), Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan.
¹⁵ Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.

PMID: 39635941
DOI: 10.1111/ggi.15001

Abstract

Background: Anticholinergic burden, reflecting the cumulative impact of medications with anticholinergic properties, significantly predicts adverse drug reactions and geriatric syndromes in older adults. Although anticholinergic risk scales (ARS) have been developed and validated in various countries, none have been tailored specifically for Japan. The Japanese Anticholinergic Risk Scale (JARS) was developed to adapt the existing ARS frameworks to the Japanese context, considering unique medication profiles and cultural factors.

Process: First, a systematic review was performed to follow the protocol registered in PROSPERO (CRD42017076510). A PubMed search from October 2017 to March 2023 was conducted to identify ARS publications post-September 2017. Based on two algorithms, average scores from the existing scores were used to develop JARS. The Delphi method, an expert consensus approach, was applied to determine the scores for medications that were not established by the algorithms. Sixteen articles identified in our systematic review contributed to JARS development. JARS categorizes 158 medications into three potency groups: 37 drugs scored as 3 (strong), 27 as 2 (moderate), and 94 as 1 (weak).

Conclusion: JARS, the newly developed ARS, could be a critical tool for anticholinergic burden assessment in older Japanese populations. Developed through a systematic review and Delphi-based expert consensus, it encompasses 158 medications, offering a comprehensive anticholinergic burden assessment. Future studies and updates should be conducted to improve the accuracy and clinical applicability of this scale. Geriatr Gerontol Int 2024; ••: ••-••.

Keywords: Delphi method; adverse drug reactions; anticholinergic risk scale.