Anticholinergics Speed Physical Decline in Older Adults

TOPLINE:

Higher anticholinergic exposure was associated with accelerated decline in gait speed (-0.0132 m/s per year) and grip strength in older adults, with effects most pronounced within 4-6 years of exposure. A cohort study of 4283 participants found that sustained high use of anticholinergics could lead to clinically meaningful physical performance decline. Clinicians should consider assessing and reducing anticholinergic medications in their older patients.

METHODOLOGY:

• Researchers analyzed data from 4283 participants in the Adult Changes in Thought Study at Kaiser Permanente Washington, with follow-up from February 1994 to March 2020.
• Analysis included 4210 participants (2468 women [58.6%]; mean age, 74.3 years) for gait speed assessment and 4200 participants for grip strength evaluation, with a mean follow-up of 8.2 years.
• Investigators examined conventional anticholinergic exposures using 10-year total standardized daily dose and 2-year mean standardized daily dose, along with weighted cumulative exposures over various time windows.
• Outcome measures included adjusted linear models with generalized estimating equations to estimate mean differences in change rates of gait speed and grip strength between exposure categories.

TAKEAWAY:

• Participants with a 10-year total standardized daily dose ≥ 1096 showed a significantly greater gait speed decline (mean difference per year, -0.0132 m/s; 95% CI, -0.0070 to -0.0193 m/s) than nonusers.
• The 4-year weighted cumulative exposure model demonstrated optimal fit, revealing a significantly greater decline rate in gait speed per 1-unit increase in weighted mean standardized daily dose (mean difference per year, -0.0034 m/s; 95% CI, -0.0048 to -0.0019 m/s).
• For grip strength, conventional exposures showed no significant associations, but the 6-year weighted cumulative exposure model revealed optimal fit (mean difference per year, -0.0329 kg; 95% CI, -0.0612 to -0.0046).

IN PRACTICE:

“Higher anticholinergic exposure was associated with accelerated decline in physical performance, consistent with clinically meaningful decline. These findings suggest that minimizing anticholinergic medications is important for healthy aging,” wrote the authors of the study.

SOURCE:

The study was led by Shelly L. Gray, PharmD, MS, Department of Pharmacy, School of Pharmacy, University of Washington in Seattle. It was published online on July 10 in JAMA Network Open.

LIMITATIONS:

Despite adjusting for numerous potential confounders, the researchers noted possible confounding by indication, and unmeasured or residual confounding could bias their estimates. The study population was predominantly White and well educated, which may limit generalizability. Additionally, exposure misclassification was possible due to incomplete capture of first-generation antihistamines available over-the-counter or prescriptions filled at external pharmacies, though approximately 97% of Kaiser Permanente Washington enrollees obtain their medications from Kaiser Permanente Washington pharmacies.

DISCLOSURES:

The research was funded by the National Institute on Aging and the Plein Center for Aging at the University of Washington School of Pharmacy. Yu-Ru Su reported receiving grants from the National Institutes of Health outside the submitted work. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.