Anticholinergic Use and Recurrent Falls in Community-Dwelling Older Adults: Findings From the Health ABC Study

Zachary A. Marcum, Subashan Perera, Joshua M. Thorpe, Galen E. Switzer, Shelly L. Gray, Nicholas G. Castle, Elsa S. Strotmeyer, Eleanor Marie Simonsick, Douglas C. Bauer, Ronald I. Shorr, Stephanie A. Studenski, Joseph T. Hanlon

Research output: Contribution to journalArticle

Abstract

Background: Although it is generally accepted that anticholinergic use may lead to a fall, results from studies assessing the association between anticholinergic use and falls are mixed. In addition, direct evidence of an association between use of anticholinergic medications and recurrent falls among community-dwelling elders is not available. Objective: To assess the association between anticholinergic use across multiple anticholinergic subclasses, including over-the-counter medications, and recurrent falls. Methods: This was a longitudinal analysis of 2948 participants, with data collected via interview at year 1 from the Health, Aging and Body Composition study and followed through year 7 (1997-2004). Self-reported use of anticholinergic medication was identified at years 1, 2, 3, 5, and 6 as defined by the list from the 2015 American Geriatrics Society Beers Criteria. Dosage and duration were also examined. The main outcome was recurrent falls (≥2) in an ensuing 12-month period from each medication data collection. Results: Using multivariable generalized estimating equation models, controlling for demographic, health status/behaviors, and access-to-care factors, a 34% increase in likelihood of recurrent falls in anticholinergic users (adjusted odds ratio = 1.34; 95% CI = 0.93-1.93) was observed, but the results were not statistically significant; similar results were found with higher doses and longer duration of use. Conclusion: Increased point estimates suggest an association of anticholinergic use with recurrent falls, but the associations did not reach statistical significance. Future studies are needed for more definitive evidence and to examine other measures of anticholinergic burden and associations with more intermediate adverse effects such as cognitive function.

Original languageEnglish (US)
Pages (from-to)1214-1221
Number of pages8
JournalAnnals of Pharmacotherapy
Volume49
Issue number11
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

Fingerprint

Independent Living
Cholinergic Antagonists
Health
Body Composition
Cognition
Health Status
Odds Ratio
Demography
Interviews

Keywords

  • accidental falls
  • cholinergic antagonist
  • older adults
  • pharmacoepidemiology

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Marcum, Z. A., Perera, S., Thorpe, J. M., Switzer, G. E., Gray, S. L., Castle, N. G., ... Hanlon, J. T. (2015). Anticholinergic Use and Recurrent Falls in Community-Dwelling Older Adults: Findings From the Health ABC Study. Annals of Pharmacotherapy, 49(11), 1214-1221. https://doi.org/10.1177/1060028015596998

Anticholinergic Use and Recurrent Falls in Community-Dwelling Older Adults : Findings From the Health ABC Study. / Marcum, Zachary A.; Perera, Subashan; Thorpe, Joshua M.; Switzer, Galen E.; Gray, Shelly L.; Castle, Nicholas G.; Strotmeyer, Elsa S.; Simonsick, Eleanor Marie; Bauer, Douglas C.; Shorr, Ronald I.; Studenski, Stephanie A.; Hanlon, Joseph T.

In: Annals of Pharmacotherapy, Vol. 49, No. 11, 01.11.2015, p. 1214-1221.

Research output: Contribution to journalArticle

Marcum, ZA, Perera, S, Thorpe, JM, Switzer, GE, Gray, SL, Castle, NG, Strotmeyer, ES, Simonsick, EM, Bauer, DC, Shorr, RI, Studenski, SA & Hanlon, JT 2015, 'Anticholinergic Use and Recurrent Falls in Community-Dwelling Older Adults: Findings From the Health ABC Study', Annals of Pharmacotherapy, vol. 49, no. 11, pp. 1214-1221. https://doi.org/10.1177/1060028015596998
Marcum, Zachary A. ; Perera, Subashan ; Thorpe, Joshua M. ; Switzer, Galen E. ; Gray, Shelly L. ; Castle, Nicholas G. ; Strotmeyer, Elsa S. ; Simonsick, Eleanor Marie ; Bauer, Douglas C. ; Shorr, Ronald I. ; Studenski, Stephanie A. ; Hanlon, Joseph T. / Anticholinergic Use and Recurrent Falls in Community-Dwelling Older Adults : Findings From the Health ABC Study. In: Annals of Pharmacotherapy. 2015 ; Vol. 49, No. 11. pp. 1214-1221.
@article{e370084787f646e9ba1f0afcbccc0280,
title = "Anticholinergic Use and Recurrent Falls in Community-Dwelling Older Adults: Findings From the Health ABC Study",
abstract = "Background: Although it is generally accepted that anticholinergic use may lead to a fall, results from studies assessing the association between anticholinergic use and falls are mixed. In addition, direct evidence of an association between use of anticholinergic medications and recurrent falls among community-dwelling elders is not available. Objective: To assess the association between anticholinergic use across multiple anticholinergic subclasses, including over-the-counter medications, and recurrent falls. Methods: This was a longitudinal analysis of 2948 participants, with data collected via interview at year 1 from the Health, Aging and Body Composition study and followed through year 7 (1997-2004). Self-reported use of anticholinergic medication was identified at years 1, 2, 3, 5, and 6 as defined by the list from the 2015 American Geriatrics Society Beers Criteria. Dosage and duration were also examined. The main outcome was recurrent falls (≥2) in an ensuing 12-month period from each medication data collection. Results: Using multivariable generalized estimating equation models, controlling for demographic, health status/behaviors, and access-to-care factors, a 34{\%} increase in likelihood of recurrent falls in anticholinergic users (adjusted odds ratio = 1.34; 95{\%} CI = 0.93-1.93) was observed, but the results were not statistically significant; similar results were found with higher doses and longer duration of use. Conclusion: Increased point estimates suggest an association of anticholinergic use with recurrent falls, but the associations did not reach statistical significance. Future studies are needed for more definitive evidence and to examine other measures of anticholinergic burden and associations with more intermediate adverse effects such as cognitive function.",
keywords = "accidental falls, cholinergic antagonist, older adults, pharmacoepidemiology",
author = "Marcum, {Zachary A.} and Subashan Perera and Thorpe, {Joshua M.} and Switzer, {Galen E.} and Gray, {Shelly L.} and Castle, {Nicholas G.} and Strotmeyer, {Elsa S.} and Simonsick, {Eleanor Marie} and Bauer, {Douglas C.} and Shorr, {Ronald I.} and Studenski, {Stephanie A.} and Hanlon, {Joseph T.}",
year = "2015",
month = "11",
day = "1",
doi = "10.1177/1060028015596998",
language = "English (US)",
volume = "49",
pages = "1214--1221",
journal = "Annals of Pharmacotherapy",
issn = "1060-0280",
publisher = "Harvey Whitney Books Company",
number = "11",

}

TY - JOUR

T1 - Anticholinergic Use and Recurrent Falls in Community-Dwelling Older Adults

T2 - Findings From the Health ABC Study

AU - Marcum, Zachary A.

AU - Perera, Subashan

AU - Thorpe, Joshua M.

AU - Switzer, Galen E.

AU - Gray, Shelly L.

AU - Castle, Nicholas G.

AU - Strotmeyer, Elsa S.

AU - Simonsick, Eleanor Marie

AU - Bauer, Douglas C.

AU - Shorr, Ronald I.

AU - Studenski, Stephanie A.

AU - Hanlon, Joseph T.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background: Although it is generally accepted that anticholinergic use may lead to a fall, results from studies assessing the association between anticholinergic use and falls are mixed. In addition, direct evidence of an association between use of anticholinergic medications and recurrent falls among community-dwelling elders is not available. Objective: To assess the association between anticholinergic use across multiple anticholinergic subclasses, including over-the-counter medications, and recurrent falls. Methods: This was a longitudinal analysis of 2948 participants, with data collected via interview at year 1 from the Health, Aging and Body Composition study and followed through year 7 (1997-2004). Self-reported use of anticholinergic medication was identified at years 1, 2, 3, 5, and 6 as defined by the list from the 2015 American Geriatrics Society Beers Criteria. Dosage and duration were also examined. The main outcome was recurrent falls (≥2) in an ensuing 12-month period from each medication data collection. Results: Using multivariable generalized estimating equation models, controlling for demographic, health status/behaviors, and access-to-care factors, a 34% increase in likelihood of recurrent falls in anticholinergic users (adjusted odds ratio = 1.34; 95% CI = 0.93-1.93) was observed, but the results were not statistically significant; similar results were found with higher doses and longer duration of use. Conclusion: Increased point estimates suggest an association of anticholinergic use with recurrent falls, but the associations did not reach statistical significance. Future studies are needed for more definitive evidence and to examine other measures of anticholinergic burden and associations with more intermediate adverse effects such as cognitive function.

AB - Background: Although it is generally accepted that anticholinergic use may lead to a fall, results from studies assessing the association between anticholinergic use and falls are mixed. In addition, direct evidence of an association between use of anticholinergic medications and recurrent falls among community-dwelling elders is not available. Objective: To assess the association between anticholinergic use across multiple anticholinergic subclasses, including over-the-counter medications, and recurrent falls. Methods: This was a longitudinal analysis of 2948 participants, with data collected via interview at year 1 from the Health, Aging and Body Composition study and followed through year 7 (1997-2004). Self-reported use of anticholinergic medication was identified at years 1, 2, 3, 5, and 6 as defined by the list from the 2015 American Geriatrics Society Beers Criteria. Dosage and duration were also examined. The main outcome was recurrent falls (≥2) in an ensuing 12-month period from each medication data collection. Results: Using multivariable generalized estimating equation models, controlling for demographic, health status/behaviors, and access-to-care factors, a 34% increase in likelihood of recurrent falls in anticholinergic users (adjusted odds ratio = 1.34; 95% CI = 0.93-1.93) was observed, but the results were not statistically significant; similar results were found with higher doses and longer duration of use. Conclusion: Increased point estimates suggest an association of anticholinergic use with recurrent falls, but the associations did not reach statistical significance. Future studies are needed for more definitive evidence and to examine other measures of anticholinergic burden and associations with more intermediate adverse effects such as cognitive function.

KW - accidental falls

KW - cholinergic antagonist

KW - older adults

KW - pharmacoepidemiology

UR - http://www.scopus.com/inward/record.url?scp=84944613435&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84944613435&partnerID=8YFLogxK

U2 - 10.1177/1060028015596998

DO - 10.1177/1060028015596998

M3 - Article

C2 - 26228936

AN - SCOPUS:84944613435

VL - 49

SP - 1214

EP - 1221

JO - Annals of Pharmacotherapy

JF - Annals of Pharmacotherapy

SN - 1060-0280

IS - 11

ER -