Work

Anticholinergic Burden and Falls in Older Adults: The Role of Functional Status

Year: 2026

Type: article

Abstract: Background: Falls are a major geriatric problem associated with functional decline, loss of independence, and increased healthcare utilization. Although anticholinergic burden and impaired functional status are recognized risk factors, their combined association with recurrent falls remains unclear. This study evaluated how anticholinergic burden and functional status relate to recurrent falls in older adults. Methods: This retrospective cross-sectional study included 347 patients aged ≥65 years who underwent comprehensive geriatric assessment. Anticholinergic burden was assessed with the Anticholinergic Cognitive Burden (ACB) score, functional status with the Barthel Index and Lawton Instrumental Activities of Daily Living (IADL) Scale, and comorbidity with the Charlson Comorbidity Index. Univariable and multivariable logistic regression and receiver operating characteristic analyses were performed; the interaction between ACB ≥ 2 and functional impairment was also tested. Results: Recurrent falls were reported by 108 patients (31.1%). Patients with recurrent falls were older, had higher medication use, ACB scores, and comorbidity burden, and lower Barthel Index and Lawton IADL scores (all p < 0.05). In univariable analyses, ACB scores of 2 and 3 were associated with increased odds of recurrent falls. In multivariable analyses, both the Barthel Index (aOR = 0.96, 95% CI: 0.94–0.98; p < 0.05) and Lawton IADL score (aOR = 0.91, 95% CI: 0.87–0.96; p < 0.05) remained independently associated with recurrent falls. The Barthel Index and Lawton IADL Scale showed the highest discriminatory performance (AUC = 0.75 and 0.74, respectively). Patients with Lawton IADL ≤ 19 and ACB ≥ 2 had the strongest combined association with recurrent falls (OR = 12.04, 95% CI: 5.88–24.66; p < 0.05). This association remained significant after multivariable adjustment for age, sex, number of medications, and comorbidity burden (aOR = 7.93, 95% CI: 3.51–17.90; p < 0.001). The interaction between ACB ≥ 2 and functional impairment was not statistically significant (p for interaction = 0.271 for the Barthel Index and 0.285 for the Lawton IADL Scale); therefore, the findings are described as joint (combined) associations rather than effect modification. Conclusions: Functional status remained independently associated with recurrent falls after adjustment for age, sex, anticholinergic burden, medication count, and comorbidity burden. In this cross-sectional study, functional impairment and higher anticholinergic burden showed a joint association with recurrent falls, without evidence of statistical interaction; longitudinal studies are needed to clarify temporal and causal relationships.

Source: Journal of Clinical Medicine

DOI: 10.3390/jcm15207811

Authors: Feyza Mutlay, Murat Das

Institution: Çanakkale Onsekiz Mart Üniversitesi

Language: English

Topic: Balance, Gait, and Falls Prevention

Subfield: Physical Therapy, Sports Therapy and Rehabilitation

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,137