Frailty status and increased risk for falls: The role of anticholinergic burden

• Published in: Archives of gerontology and geriatrics 2020-09, Vol.90, p.104136, Article 104136
• Main Authors: Naharci, Mehmet Ilkin, Tasci, Ilker
• Format: Article
• Language: English
• Subjects: Accidental Falls; Aged; Anticholinergics; Cholinergic Antagonists - adverse effects; Falls; Female; Frail Elderly; Frailty; Frailty - chemically induced; Frailty - epidemiology; Humans; Independent Living; Male
• ISSN: 0167-4943; 1872-6976
• DOI: 10.1016/j.archger.2020.104136

•The use of any drugs with possible or definite anticholinergic properties is associated with an increased risk of falls in frail older adults.•The emergence of individual frailty components as a consequence of anticholinergic drug use might mediate the higher risk of falls in frailty.•Anticholinergic drug deprescription may be important for reducing the risk of falls in older adults with frailty characteristics. Frailty leads to serious adverse outcomes including falls. The relationship between frailty and falls has not been evaluated in the context of the side effects of drugs with anticholinergic properties. The aim of this study was to examine the potential association of anticholinergic burden (ACB) with the risk of falls among frail older adults. Community-dwelling older adults were consecutively selected from the geriatrics outpatient clinic. Based on a fall history in the last 12 months, the participants were grouped as fallers and non-fallers. Frailty status was assessed by Fried’s phenotype method. Exposure to anticholinergic medications was estimated using the ACB scale, and the participants were classified into ACB_0 (none), ACB_1 (possible) and ACB_2+ (definite). The study included 520 older adults (mean age 77.7 years, 62.7 % female), with a fall prevalence of 25.8 % 12 months past. The proportions of frailty and pre-frailty were 33.1 % and 57.4 %, respectively. After adjustment for study confounders, receiving at least 1 drug with either possible or definite anticholinergic properties was independently associated to falls in frail [OR = 3.84 (1.48−9.93), p = 0.006] and pre-frail participants [OR = 2.71 (1.25−5.89); p = 0.012], but not in robust subjects. Moreover, ACB was significantly associated with the frailty components on adjusted analysis (p’s