Use of medications with anticholinergic activity and self-reported injurious falls in older community-dwelling adults

Kathryn Richardson, Kathleen Bennett, Ian D. Maidment, Chris Fox, David Smithard, Rose Anne Kenny

Research output: Contribution to journalArticle

Abstract

Objectives: To assess the association between the use of medications with anticholinergic activity and the subsequent risk of injurious falls in older adults. Design: Prospective, population-based study using data from The Irish Longitudinal Study on Ageing. Setting: Irish population. Participants: Community-dwelling men and women without dementia aged 65 and older (N = 2,696).

Measurements: Self-reported injurious falls reported once approximately 2 years after baseline interview. Self-reported regular medication use at baseline interview. Pharmacy dispensing records from the Irish Health Service Executive Primary Care Reimbursement Service in a subset (n = 1,553).

Results: Nine percent of men and 17% of women reported injurious falls. In men, the use of medications with definite anticholinergic activity was associated with greater risk of subsequent injurious falls (adjusted relative risk (aRR) = 2.55, 95% confidence interval (CI) = 1.33-4.88), but the risk of having any fall and the number of falls reported were not significantly greater. Greater anticholinergic burden was associated with greater injurious falls risk. No associations were observed for women. Findings were similar using pharmacy dispensing records. The aRR for medications with definite anticholinergic activity dispensed in the month before baseline and subsequent injurious falls in men was 2.53 (95% CI = 1.15-5.54).

Conclusion: The regular use of medications with anticholinergic activity is associated with subsequent injurious falls in older men, although falls were self-reported after a 2-year recall and so may have been underreported. Further research is required to validate this finding in men and to consider the effect of duration and dose of anticholinergic medications.

LanguageEnglish
Pages1561-1569
Number of pages9
JournalJournal of the American Geriatrics Society
Volume63
Issue number8
Early online date22 Jul 2015
DOIs
Publication statusPublished - 2015

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Independent Living
Cholinergic Antagonists
Confidence Intervals
Interviews
Population
Health Services
Longitudinal Studies
Dementia
Primary Health Care
Research

Bibliographical note

This is the peer reviewed version of the following article: Richardson, K., Bennett, K., Maidment, I. D., Fox, C., Smithard, D., & Kenny, R. A. (2015). Use of medications with anticholinergic activity and self-reported injurious falls in older community-dwelling adults. Journal of the American Geriatrics Society, 63(8), 1561-1569, which has been published in final form at http://dx.doi.org/10.1111/jgs.13543. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

Keywords

  • anticholinergic
  • antimuscarinic
  • elderly
  • falls
  • injury

Cite this

Richardson, Kathryn ; Bennett, Kathleen ; Maidment, Ian D. ; Fox, Chris ; Smithard, David ; Kenny, Rose Anne. / Use of medications with anticholinergic activity and self-reported injurious falls in older community-dwelling adults. In: Journal of the American Geriatrics Society. 2015 ; Vol. 63, No. 8. pp. 1561-1569.
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abstract = "Objectives: To assess the association between the use of medications with anticholinergic activity and the subsequent risk of injurious falls in older adults. Design: Prospective, population-based study using data from The Irish Longitudinal Study on Ageing. Setting: Irish population. Participants: Community-dwelling men and women without dementia aged 65 and older (N = 2,696). Measurements: Self-reported injurious falls reported once approximately 2 years after baseline interview. Self-reported regular medication use at baseline interview. Pharmacy dispensing records from the Irish Health Service Executive Primary Care Reimbursement Service in a subset (n = 1,553). Results: Nine percent of men and 17{\%} of women reported injurious falls. In men, the use of medications with definite anticholinergic activity was associated with greater risk of subsequent injurious falls (adjusted relative risk (aRR) = 2.55, 95{\%} confidence interval (CI) = 1.33-4.88), but the risk of having any fall and the number of falls reported were not significantly greater. Greater anticholinergic burden was associated with greater injurious falls risk. No associations were observed for women. Findings were similar using pharmacy dispensing records. The aRR for medications with definite anticholinergic activity dispensed in the month before baseline and subsequent injurious falls in men was 2.53 (95{\%} CI = 1.15-5.54).Conclusion: The regular use of medications with anticholinergic activity is associated with subsequent injurious falls in older men, although falls were self-reported after a 2-year recall and so may have been underreported. Further research is required to validate this finding in men and to consider the effect of duration and dose of anticholinergic medications.",
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Use of medications with anticholinergic activity and self-reported injurious falls in older community-dwelling adults. / Richardson, Kathryn; Bennett, Kathleen; Maidment, Ian D.; Fox, Chris; Smithard, David; Kenny, Rose Anne.

In: Journal of the American Geriatrics Society, Vol. 63, No. 8, 2015, p. 1561-1569.

Research output: Contribution to journalArticle

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N2 - Objectives: To assess the association between the use of medications with anticholinergic activity and the subsequent risk of injurious falls in older adults. Design: Prospective, population-based study using data from The Irish Longitudinal Study on Ageing. Setting: Irish population. Participants: Community-dwelling men and women without dementia aged 65 and older (N = 2,696). Measurements: Self-reported injurious falls reported once approximately 2 years after baseline interview. Self-reported regular medication use at baseline interview. Pharmacy dispensing records from the Irish Health Service Executive Primary Care Reimbursement Service in a subset (n = 1,553). Results: Nine percent of men and 17% of women reported injurious falls. In men, the use of medications with definite anticholinergic activity was associated with greater risk of subsequent injurious falls (adjusted relative risk (aRR) = 2.55, 95% confidence interval (CI) = 1.33-4.88), but the risk of having any fall and the number of falls reported were not significantly greater. Greater anticholinergic burden was associated with greater injurious falls risk. No associations were observed for women. Findings were similar using pharmacy dispensing records. The aRR for medications with definite anticholinergic activity dispensed in the month before baseline and subsequent injurious falls in men was 2.53 (95% CI = 1.15-5.54).Conclusion: The regular use of medications with anticholinergic activity is associated with subsequent injurious falls in older men, although falls were self-reported after a 2-year recall and so may have been underreported. Further research is required to validate this finding in men and to consider the effect of duration and dose of anticholinergic medications.

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