Older adult risk classification for anticholinergics (ORCA): a Delphi panel-validated scale

Area of Science:

• Geriatric Medicine
• Clinical Pharmacology
• Drug Safety

Background:

• Drugs with anticholinergic properties (DAP) are commonly used in older adults but linked to adverse outcomes like cognitive decline and falls.
• Existing anticholinergic scales lack clinical perspective and vary significantly, hindering practical application.
• The Older Adult Risk Classification for Anticholinergics (ORCA) scale was developed to integrate clinical expertise with evidence.

Purpose of the Study:

• To develop and validate a clinically informed, evidence-based anticholinergic burden scale specifically for older adults.
• To provide a standardized tool for assessing the risk associated with DAP in the geriatric population.

Main Methods:

• A preliminary drug list was compiled from a systematic review.
• A two-round Delphi process involving 14 European geriatric medicine and clinical pharmacology experts was conducted.
• Experts rated drug anticholinergic burden using a four-point Likert scale, with consensus determined by the Lynn method.

Main Results:

• 233 drugs were assessed, with 17 classified as having no anticholinergic properties, 115 as low, 31 as moderate, and 65 as high burden.
• Central nervous system drugs, particularly antipsychotics and antidepressants, constituted the majority of assessed DAP.
• Consensus was not reached for five drugs.

Conclusions:

• The ORCA scale offers a standardized, clinically informed, and evidence-based classification of DAP for older adults.
• This scale aims to enhance prescribing safety and guide therapeutic decision-making for clinicians, pharmacists, and researchers.
• The ORCA scale addresses a critical need for a reliable tool to manage anticholinergic burden in a vulnerable population.