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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Washington, Seattle, WA, USA zmarcum@uw.edu.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Marcum
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Thorpe
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
authors.forename: Galen E
authors.initials: GE
authors.lastname: Switzer
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Shelly L
authors.initials: SL
authors.lastname: Gray
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Castle
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.affiliation: National Institute on Aging, Baltimore, MD, USA.
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Simonsick
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.affiliation: Veterans Affairs Medical Center, Gainesville, FL, USA.
authors.forename: Ronald I
authors.initials: RI
authors.lastname: Shorr
authors.affiliation: National Institute on Aging, Baltimore, MD, USA.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Studenski
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012008:Recurrence; D057566:Self Report
chemical_list: D018680:Cholinergic Antagonists
keywords: accidental falls; cholinergic antagonist; older adults; pharmacoepidemiology