Anticholinergics and falls in older adults

ABSTRACT

Introduction

The use of medications with anticholinergic (ACh) properties is associated with numerous adverse effects especially in older adults. Emerging evidence suggests the presence of long-term effects with ACh use.

Areas covered

Our article presents an overview of ACh effects and falls in older individuals including examination of emerging evidence on ACh use and cumulative exposure on short-term and long-term falls risk. The databases CINAHL, MEDLINE, EMBASE, and Web of Science were searched for articles published from January 2002 to December 2021.

Expert opinion

Anticholinergic side effects include muscle weakness, blurred vision, and mental confusion which are likely to lead to increased falls risk. Many commonly used medications such as beta-blockers, calcium-channel blockers, and antihistamines are now known to have mild ACh properties. With polypharmacy now considered unavoidable in older patients, the cumulative effects of the use of multiple drugs with mild ACh properties may also lead to increased falls risk. The relationship between ACh drugs and falls may also be irreversible as ACh effects may extend beyond the period of drug use, due to cognitive and physical deconditioning following the initial exposure to ACh drugs. Future long-term studies with accurate quantification of cumulative ACh exposure and measurement of actual falls outcomes are urgently required.

KEYWORDS:

• Anticholinergic syndrome
• accidental falls
• aged
• polypharmacy
• drug-related side effects and adverse reactions

Article highlights

• Anticholinergic effects of medications including muscle weakness, blurred vision, and mental confusion are associated with increased risk of falls.

• Commonly used medications, including some antihypertensives and antihistamines, may have mild anticholinergic properties.

• The cumulative use of drugs with mild anticholinergic properties may lead to increased falls risk.

Exposure to anticholinergic medications may be associated with long-term increased risk of falls in older adults.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The co-authors of this study are recipients of the Transforming Cognitive Frailty into Later-Life Self-Sufficiency (AGELESS) study which is funded by the Ministry of Higher Education Long-Term Research Grant Scheme (LRGS/1/2019/UM/01/1/1).