Anticholinergic drugs and negative outcomes in the older population: from biological plausibility to clinical evidence.
The use of medication with anticholinergic properties is widespread among older subjects. Many drugs of common use such as antispasmodics, bronchodilators, antiarrhythmics, antihistamines, anti-hypertensive drugs, antiparkinson agents, skeletal muscle relaxants, and psychotropic drugs have been demonstrated to have an anticholinergic activity. The most frequent adverse effects are dry mouth, nausea, vomiting, constipation, abdominal pain, urinary retention, blurred vision, tachycardia and neurologic impairment such as confusion, agitation and coma. A growing evidence from experimental studies and clinical observations suggests that drugs with anticholinergic properties can cause physical and mental impairment in the elderly population. However, the morbidity and management issues associated with unwanted anticholinergic activity are underestimated and frequently overlooked. Moreover, their possible relation with specific negative outcome in the elderly population is still not firmly established. The aim of the present review was to evaluate the relationship between the use of drugs with anticholinergic activity and negative outcomes in older persons. We searched PubMed and Cochrane combining the search terms "anticholinergic", "delirium", "cognitive impairment", "falls", "mortality" and "discontinuation". Medicines with anticholinergic properties may increase the risks of functional and cognitive decline, morbidity, institutionalization and mortality in older people. However, such evidences are still not conclusive probably due to possible confounding factors. In particular, more studies are needed to investigate the effects of discontinuation of drug with anticholinergic properties. Overall, minimizing anticholinergic burden should always be encouraged in clinical practice to improve short-term memory, confusion and delirium, quality of life and daily functioning.
Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy.
Agnese
A
Collamati
Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy.
Anna Maria
AM
Martone
Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy.
Andrea
A
Poscia
Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy.
Vincenzo
V
Brandi
Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy.
Michela
M
Celi
Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy.
Emanuele
E
Marzetti
Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy.
Antonio
A
Cherubini
Department of Gerontology, Orthopedics and Neuroscience, Catholic University of Sacred Heart, Rome, Italy. francesco.landi@rm.unicatt.it.
Francesco
F
Landi
D000058:Accidental Falls; D000368:Aged; D000375:Aging / Q000187:drug effects* / Q000502:physiology / Q000523:psychology; D018680:Cholinergic Antagonists / Q000145:classification / Q000494:pharmacology; D003072:Cognition Disorders / Q000139:chemically induced; D003693:Delirium / Q000139:chemically induced; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D011788:Quality of Life
D018680:Cholinergic Antagonists
Anticholinergic drugs; Cognitive impairment; Delirium; Falls; Mortality; Physical performance; Side effects