Anticholinergic Burden and the Risk of Falls Among Elderly Psychiatric Inpatients: A 4-Year Case-Control Study

Abstract

Objective: Falls are an everyday risk for the elderly and their etiology is multifactorial. Because there are little data focusing on falls among elderly psychiatric inpatients, we aimed to retrospectively assess the characteristics of inpatients that had sustained a fall during hospitalization. Methods: Over 4 years, all adverse-event reports of falls were reviewed. Inclusion criteria were age > 65 years and intact cognition. The control group consisted of the previous and next admission of an elderly patient to the same ward. Anti-cholinergic score was calculated for each patient. Results: Of 414 admissions of elderly patients, 34 (8.2%) patients had had a fall. The control group (n = 68) did not differ in mean age, distribution of diagnoses, or use of benzodiazepines, antidepressants, or antipsychotics. Two variables were significantly associated with falls: female gender (68% vs. 39%, p < .05) and anticholinergic burden score (ABS) (mean: 3.7 vs. 2.1, p < .05). Conclusions: Our results support reported findings of higher rates of falls among elderly women and suggest that ABS may be a risk factor for falls.

Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study

“…There is no universally accepted method yet to assess and quantify the anticholinergic burden. Older measures of anticholinergic medication exposure were developed based on clinical experience and knowledge of the pharmacological properties of the medications drawn from the literature 33 34. Serum radioreceptor assay quantifying the drug induced muscarinic blockade has been used to detect serum AA 35 36.…”

Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study

“…Cholinergic side effects, or anticholinergic burden, may be quantified ( a ) by means of a serum radioreceptor assay to quantify drug induced muscarinic blockade13 17 18 or ( b ) by the summation of average estimated clinical effects of specific drugs 19. The former has greater biological precision but is essentially a transient global measure that may not represent cerebral levels because of the differential permeability of the blood-brain barrier.…”

Use of medications with anticholinergic properties and cognitive function in a young‐old community sample

“…Anticholinergic medications have a spectrum of side-effects particularly troublesome in the elderly including difficulty chewing, swallowing and speaking, anxiety, blurred vision and urinary disorders (Mintzer and Burns, 2000). Other negative consequences of medications with anticholinergic properties are delirium and increased dementia symptom severity (Tune et al, 1992;Han et al, 2001), falls (Aizenberg et al, 2002), constipation (Monane et al, 1993) and poorer functional ability (Landi et al, 2006). There is considerable evidence that medications with anticholinergic effects are often inappropriate for older adults (Fick et al, 2003).…”