title: Anticholinergic burden is associated with recurrent and injurious falls in older individuals.
abstract: OBJECTIVE
  While the anticholinergic activity of medications has been linked to cognitive decline, few studies have linked anticholinergic burden with falls in older people. We evaluated the relationship between anticholinergic burden and recurrent and injurious falls among community-dwelling older adults.
  
  
  METHODS
  This case-control study was performed on 428 participants aged ≥65 years, 263 cases with two or more falls or one injurious fall in the preceding 12 months, and 165 controls with no falls in the preceding 12 months. Anticholinergic burden was determined using the anticholinergic cognitive burden (ACB) scale. Upper and lower limb functional abilities were assessed with timed up and go (TUG), functional reach (FR) and grip strength (GS). Logistic regression analysis was employed to calculate the mediation effect of TUG, FR and GS on ACB associated falls.
  
  
  RESULTS
  Univariate analysis revealed a significant association between an ACB score of ≥1 with falls (OR, 1.8; 95% CI; 1.1-3.0; p=0.01) and significantly poorer TUG and FR. The association between ACB≥1 and falls was no longer significant after adjustment for either TUG (OR for ACB associated falls, 1.4; 95% CI, 0.88-2.4; p=0.14) or FR (OR for ACB associated falls, 1.4; 95% CI, 0.89-2.4, p=0.12) but remained significant with GS.
  
  
  CONCLUSIONS
  The association between recurrent and injurious falls and the use of any medications listed in the ACB scale was mediated through gait and balance impairment but not by muscular weakness, providing a novel insight into the potential mechanistic link between ACB and falls. Future studies should determine whether TUG and FR measurements could help inform risk to benefit decisions where ACB medications are being considered.
authors.affiliation: Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: Dr.anamzia@yahoo.com.
authors.forename: Anam
authors.initials: A
authors.lastname: Zia
authors.affiliation: Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: Shahrulk@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Kamaruzzaman
authors.affiliation: AGEING, Epidemiology Group, School of Medicine & Dentistry, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
authors.affiliation: Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Centre of Innovation in Medical Engineering, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: mptan@ummc.edu.my.
authors.forename: M P
authors.initials: MP
authors.lastname: Tan
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D005080:Exercise Test; D005260:Female; D005684:Gait / Q000187:drug effects*; D018737:Hand Strength; D006801:Humans; D008297:Male; D004856:Postural Balance / Q000187:drug effects*; D012008:Recurrence; D014947:Wounds and Injuries / Q000209:etiology
chemical_list: D018680:Cholinergic Antagonists
keywords: Aged; Anticholinergic Cognitive Burden; Falls; Functional Reach; Scale; Timed up and go