Physical and Cognitive Performance and Burden of Anticholinergics, Sedatives, and ACE Inhibitors in Older Women

Abstract

Polypharmacy, common in older people, confers both risk of adverse outcomes and benefits. We assessed the relationship of commonly prescribed medications with anticholinergic and sedative effects to physical and cognitive performance in older individuals. The study population comprised 932 moderately to severely disabled community-resident women aged 65 years or older who were participants in the Women's Health and Aging Study I. A scale based on pharmacodynamic principles was developed and utilized as a measure of drug burden. This was related to measures of physical and cognitive function. After adjusting for demographics and comorbidities, anticholinergic drug burden was independently associated with greater difficulty in four physical function domains with adjusted odds ratios (95% confidence interval (CI)) of 4.9 (2.0-12.0) for balance difficulty; 3.2 (1.5-6.9) for mobility difficulty; 3.6 (1.6-8.0) for slow gait; 4.2 (2.0-8.7) for chair stands difficulty; 2.4 (1.1-5.3) for weak grip strength; 2.7 (1.3-5.4) for upper extremity limitations; 3.4 (1.7-6.9) for difficulty in activities of daily living; and 2.4 (95% CI, 1.1-5.1) for poor performance on the Mini-Mental State Examination. Sedative burden was associated only with impaired grip strength (3.3 (1.5-7.3)) and mobility difficulty (2.4 (1.1-5.3)). The burden of multiple drugs can be quantified by incorporating the recommended dose regimen and the actual dose and frequency of drug taken. Anticholinergic drug burden is strongly associated with limitations in physical and cognitive function. Sedative burden is associated with impaired functioning in more limited domains. The risk associated with exposure of vulnerable older women to drugs with anticholinergic properties, and to a lesser extent those with sedative properties, implies that such drugs should not be used in this patient group without compelling clinical indication.

Do Long-Term Side Effects Matter? Evaluating the Risk of Hip Fracture in Subjects With Schizophrenia Over a Decade

“…In addition, anticholinergic medications (eg, benztropine mesylate and trihexyphenidyl) used to counter EPS, may also increase the risk of fall. 8 Does a study such as this one by Wu and colleagues 3 lead us to improve our practice? It is a bit hard to say.…”

Anti-Cholinergic Load, Health Care Utilization, and Survival in People with Advanced Cancer: A Pilot Study

“…[1][2][3][4][5][6] In a study of moderately to severely disabled women aged 65 or over and residing in the community (n ¼ 932), anti-cholinergic drug burden was independently associated with greater difficulty in several measures of physical function, after adjustment for age, education and co-morbidities. 5 Another study of well functioning community-dwelling elderly (n ¼ 3075) showed medications with anti-cholinergic effects were associated with poorer physical and cognitive performance after adjusting for socio-demographic factors and co-morbidities. 4 There is also a link with poor cognitive outcomes, especially in the group with existing cognitive impairment.…”

“…[1][2][3][4][5][6][7][8][9] Little is known about the impact of prescribing anti-cholinergic medications on outcomes pertinent to palliative care for people with advanced cancer.…”

Associations between different measures of anticholinergic drug exposure and Barthel Index in older hospitalized patients

“…An inverse correlation between DBI and markers of cognitive and physical function has been demonstrated in a range of settings [Hilmer et al 2007;Cao et al 2008;Gnjidic et al 2009Gnjidic et al , 2012aGnjidic et al , 2012bLowry et al 2012]. The ARS has been shown to be associated with confusion, constipation, falls [Rudolph et al 2008] and reduced Barthel Index (BI) [Lowry et al 2012], an established scale to assess activities of daily living and mobility [Mahoney and Barthel, 1965].…”