Association Between Objectively Measured Physical Activity and Opioid, Hypnotic, or Anticholinergic Medication Use in Older People: Data from the Physical Activity Cohort Scotland Study

Clarke, Clare; Sniehotta, Falko F; Vadiveloo, Thenmalar; Donnan, Peter T.; Witham, Miles D.

doi:10.1007/s40266-018-0578-7

Cited by 6 publications

(3 citation statements)

References 30 publications

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“…Although baseline cognitive function measured by 3MSE was not different between ACB groupings, previous studies have found that anticholinergic medications were associated with worse balance and more falls [18]. This has been speculated to occur due to a reduction in processing speed and promotion of cerebral vasculopathy and consequent white matter changes [19]. In line with our results, other studies have found that anticholinergic burden is associated with greater decline in objectively measured physical activity over time in older adults [19].…”

Section: Discussionsupporting

confidence: 88%

“…This has been speculated to occur due to a reduction in processing speed and promotion of cerebral vasculopathy and consequent white matter changes [19]. In line with our results, other studies have found that anticholinergic burden is associated with greater decline in objectively measured physical activity over time in older adults [19]. Additionally, ACB has been associated with a higher incidence of cardiovascular events, which may also demonstrate declines in mobility [20].…”

Section: Discussionsupporting

confidence: 87%

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Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study

Squires

Pahor

Manini

et al. 2020

JCM

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Anticholinergic cognitive burden (ACB) may be associated with detrimental effects on mobility and physical independence in older adults. We evaluated the incidence of major mobility disability (MMD), persistent major mobility disability (PMMD), and injurious falls among participants within the Lifestyle Interventions for Elders (LIFE) trial according to varied anticholinergic burden levels. Participants aged 70–89 years were randomized to a physical activity (PA) or successful aging (SA) intervention and evaluated by ACB medication use as a summed score of a previously developed ACB scale. Confounders included demographic characteristics, physical function, cognitive function, and fall history. Average participant follow-up was 2.6 years and included outcome assessment for MMD, PMMD, and injurious falls every six months. Adjusted proportional hazards models evaluated the independent effects of ACB scores as well as interaction effects with the intervention. Of the 1635 participants, 986 (60%) used ≥1 anticholinergic medication. Compared to those with no burden, participants with an ACB score of 1 demonstrated increased MMD (HR = 1.42 [1.13–1.78]), PMMD (HR = 1.53 [1.12–2.09]), and injurious falls (HR = 1.60 [1.10–2.32]). Results similar in magnitude were observed for all other ACB levels versus the no burden group. Stepwise dose–response comparisons between ACB groupings did not demonstrate significant differences in outcomes. Stratification by PA or SA interventions demonstrated few differences from the combined overall trial results. Compared to those not taking anticholinergic medications, participants taking anticholinergic medications generally demonstrated increased risk of MMD, PMMD, and injurious falls. Total anticholinergic burden was not associated with a stepwise dose–response relationship in mobility disability and may lack sensitivity to capture varied responses.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study

Squires

Pahor

Manini

et al. 2020

JCM

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“…The basic activities most affected by the anticholinergic action were bathing, grooming, dressing, transfers, mobility and stairs use (Lowry et al, 2011). A progressive decrease in global activity measured by accelerometers was also found (Clarke et al, 2018). A dose-response relationship between anticholinergic load and dysfunction has also been described.…”

Section: Discussionmentioning

confidence: 91%

Anticholinergic Drugs in Geriatric Psychopharmacology

López-Álvarez¹,

Sevilla‐Llewellyn‐Jones

Agüera-Ortíz³

2019

Front. Neurosci.

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Drugs with anticholinergic action are widely prescribed in the elderly population due to their potential clinical benefits. However, these benefits are limited by adverse effects which may be serious in particular circumstances. This review presents different aspects of the use of anticholinergics in old age with a focus in psychogeriatric patients. We critically review published data on benefits and disadvantages of anticholinergics, which are often controversial. Prevalence, pathophysiology and measurement methods of the anticholinergic action of drugs are discussed. We also present the most important drawbacks resulting from its use, including effects on cognition in healthy and cognitively impaired people, in aged schizophrenia patients, emergence of delirium and psychiatric symptoms, influence in functionality, hospitalization, institutionalization and mortality, and the potential benefits and limitations of their discontinuation. Finally, we suggest practical recommendations for the safe use of anticholinergics in clinical conditions affecting elderly patients, such as dementia, schizophrenia and acute hallucinatory episodes, depression, anxiety, Parkinson’s disease, cardiovascular conditions and urinary incontinence.

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Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review

Lisibach

Benelli

Ceppi

et al. 2020

Eur J Clin Pharmacol

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Purpose Older people are at risk of anticholinergic side effects due to changes affecting drug elimination and higher sensitivity to drug’s side effects. Anticholinergic burden scales (ABS) were developed to quantify the anticholinergic drug burden (ADB). We aim to identify all published ABS, to compare them systematically and to evaluate their associations with clinical outcomes. Methods We conducted a literature search in MEDLINE and EMBASE to identify all published ABS and a Web of Science citation (WoS) analysis to track validation studies implying clinical outcomes. Quality of the ABS was assessed using an adapted AGREE II tool. For the validation studies, we used the Newcastle-Ottawa Scale and the Cochrane tool Rob2.0. The validation studies were categorized into six evidence levels based on the propositions of the Oxford Center for Evidence-Based Medicine with respect to their quality. At least two researchers independently performed screening and quality assessments. Results Out of 1297 records, we identified 19 ABS and 104 validations studies. Despite differences in quality, all ABS were recommended for use. The anticholinergic cognitive burden (ACB) scale and the German anticholinergic burden scale (GABS) achieved the highest percentage in quality. Most ABS are validated, yet validation studies for newer scales are lacking. Only two studies compared eight ABS simultaneously. The four most investigated clinical outcomes delirium, cognition, mortality and falls showed contradicting results. Conclusion There is need for good quality validation studies comparing multiple scales to define the best scale and to conduct a meta-analysis for the assessment of their clinical impact.

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Association Between Objectively Measured Physical Activity and Opioid, Hypnotic, or Anticholinergic Medication Use in Older People: Data from the Physical Activity Cohort Scotland Study

Abstract: Anticholinergic burden is associated with greater decline in objectively measured physical activity over time in older people, a finding not seen with hypnotic or opioid use.

Cited by 6 publications

References 30 publications

Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study

Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study

Anticholinergic Drugs in Geriatric Psychopharmacology

Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review

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