Anticholinergic and Sedative Medications and Dynamic Gait Parameters in Older Patients

Abstract

Background Anticholinergic and sedative medications are associated with poorer physical function in older age. Gait and physical function have traditionally been assessed with the time needed to execute objective function tests. Accelerometerbased gait parameters provide a precise capturing of gait dynamics and patterns and as such have added value. Objectives This study examined the associations between cumulative exposure to anticholinergic and sedative medications and gait dimensions as assessed with accelerometer-based dynamic gait parameters. Methods Data were collected from outpatients of a diagnostic geriatric day clinic who underwent a comprehensive geriatric assessment (CGA). Cumulative exposure to anticholinergic and sedative medications was quantified with the Drug Burden Index (DBI), a linear additive pharmacological dose-response model. From a total of 22 dynamic gait parameters, the gait dimensions 'Regularity', 'Complexity', 'Stability', 'Pace', and 'Postural Control' were derived using factor analysis (and standardized total scores for these dimensions were calculated accordingly). Data were analyzed with multivariable linear regression analysis, in which adjustment was made for the covariates age, gender, body mass index (BMI), Mini Mental State Examination (MMSE) score, Charlson Comorbidity Index (CCI) including dementia, and number of medications not included in the DBI. Results A total of 184 patients participated, whose mean age was 79.8 years (± SD 5.8), of whom 110 (60%) were women and of whom 88 (48%) had polypharmacy (i.e., received treatment with ≥5 medications). Of the 893 medications that were prescribed in total, 157 medications (17.6%) had anticholinergic and/or sedative properties. Of the patients, 100 (54%) had no exposure (DBI = 0), 42 (23%) had moderate exposure (0 > DBI ≤ 1), while another 42 (23%) had high exposure (DBI >1) to anticholinergic and sedative medications. Findings showed that high cumulative exposure to anticholinergic and sedative medications was related with poorer function on the Regularity and Pace dimensions. Furthermore, moderate and high exposure were associated with poorer function on the Complexity dimension. Conclusions These findings show that in older patients with comorbidities, cumulative anticholinergic and sedative exposure is associated with poorer function on multiple gait dimensions.

Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review

“…Full‐text articles were sought and screened for 316 articles that appeared to meet the inclusion criteria. Seventy studies 6,13–81 were included in the systematic review (Figure 1).…”

“…The details of the included studies are summarized in Supplementary Table S1. There were 65 studies conducted in humans 6,13–76 and five in animals (mice) 77–81 . Of the studies conducted in humans, there were 38 cross‐sectional studies, 14 retrospective cohort studies, 11 prospective cohort studies, one case–control study, and one mixed prospective/retrospective cohort study.…”