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Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study

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Abstract

Background

It is not known whether drugs with different anticholinergic ratings contribute proportionately to overall anticholinergic score.

Objectives

Our objective was to assess the risk of falls or fall-related injuries as a function of the overall anticholinergic score resulting from drugs with different anticholinergic ratings among people with impaired cognition.

Methods

This was a retrospective cohort study of adults aged  ≥ 65 years with mild cognitive impairment (MCI) or dementia and two or more additional chronic conditions (N = 10,698) in an integrated delivery system. Electronic health record data, including pharmacy fills and diagnosis claims, were used to assess anticholinergic medication use, quantified using the anticholinergic cognitive burden (ACB) scale, falls and fall-related injuries.

Results

During a median follow-up of 366 days, 63% of the cohort used one or more ACB drug; 2015 (18.8%) people experienced a fall or fall-related injury. Among patients with a daily ACB score of 5, the greatest increase in risk of falls or fall-related injuries was seen when level 2 and level 3 drugs were used in combination [hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.51–2.83]. Multiple ACB level 1 drugs taken together also increased the hazard of a fall or fall-related injury (HR 1.16; 95% CI 1.03–1.32). The risk of fall or fall-related injury as a function of exposure to ACB level 2 drugs (HR 1.56; 95% CI 1.16–2.10) was higher than that for ACB level 1 or 3 drugs.

Conclusions

The same daily ACB score was associated with a different degree of risk, depending on the ACB ratings of the individual drugs comprising the score. Combinations of level 2 and level 3 drugs had the greatest risk of fall or fall-related injury relative to other individuals with the same daily ACB score. Low-potency anticholinergic drugs taken together modestly increased the hazard of a fall or fall-related injury.

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Funding

This study was supported by R24AG045050-03S2 from the National Institute on Aging. Support was provided by the KPCO Pharmacy Department for Linda Weffald’s time. Dr. Boyd’s time was in part supported by 1K24AG056578-01 from the National Institute on Aging. Dr. Green is supported by K23AG054742.

Author information

Authors and Affiliations

  1. Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th Floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA

    Ariel R. Green & Cynthia M. Boyd

  2. Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA

    Liza M. Reifler, Elizabeth A. Bayliss & Linda A. Weffald

  3. Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Elizabeth A. Bayliss

  4. University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA

    Linda A. Weffald

  5. Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Cynthia M. Boyd

Authors
  1. Ariel R. Green
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  2. Liza M. Reifler
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  4. Linda A. Weffald
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Corresponding authors

Correspondence to Ariel R. Green or Cynthia M. Boyd.

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Conflict of Interest

Ariel Green, Liza Reifler, Elizabeth Bayliss, Linda A. Weffald have no conflicts of interest that are directly relevant to the content of this study. Cynthia Boyd writes a chapter on multimorbidity for UpToDate, for which she receives a royalty.

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Green, A.R., Reifler, L.M., Bayliss, E.A. et al. Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study. Drugs Aging 36, 289–297 (2019). https://doi.org/10.1007/s40266-018-00630-z

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