Higher exposure to anticholinergic medications is linked to a faster decline in physical abilities among older adults, according to a recent study. The research, which involved 4,283 participants, found that sustained high use of these drugs could lead to significant decreases in gait speed and grip strength, particularly within four to six years of exposure. The findings suggest that healthcare providers should carefully evaluate and potentially reduce anticholinergic medications in older patients to promote healthier aging.
The study, conducted by researchers from the University of Washington and published in JAMA Network Open, analyzed data from the Adult Changes in Thought Study at Kaiser Permanente Washington. The follow-up period spanned from February 1994 to March 2020, involving 4,210 participants for gait speed assessment and 4,200 for grip strength evaluation, with an average follow-up duration of 8.2 years.
Methodology and Key Findings
Researchers assessed anticholinergic exposure using several metrics, including a 10-year total standardized daily dose and a 2-year mean standardized daily dose, alongside weighted cumulative exposures over different time windows. The study utilized adjusted linear models with generalized estimating equations to estimate changes in gait speed and grip strength.
Participants with a 10-year total standardized daily dose of ≥ 1096 exhibited a significantly greater decline in gait speed (mean difference per year, -0.0132 m/s; 95% CI, -0.0070 to -0.0193 m/s) compared to nonusers.
The 4-year weighted cumulative exposure model showed the best fit, indicating a more pronounced decline 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). While conventional exposures did not significantly affect grip strength, the 6-year weighted cumulative exposure model revealed a notable decline (mean difference per year, -0.0329 kg; 95% CI, -0.0612 to -0.0046).
Clinical Implications and Expert Opinions
The study highlights the potential risks associated with prolonged anticholinergic use in older adults. “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,” the authors noted.
Shelly L. Gray, PharmD, MS, who led the research, emphasized the importance of these findings for clinicians managing older patients. “Our study underscores the need for healthcare providers to regularly review and adjust medication regimens, particularly for those involving anticholinergics,” she stated.
Limitations and Future Directions
Despite the robust findings, the study acknowledges certain limitations. The predominantly White and well-educated study population may limit the generalizability of the results. Additionally, potential confounding factors and exposure misclassification could have influenced the outcomes. The researchers noted that approximately 97% of Kaiser Permanente Washington enrollees obtain their medications from Kaiser Permanente Washington pharmacies, but incomplete data capture of over-the-counter or externally filled prescriptions remains a concern.
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, one of the researchers, disclosed receiving grants from the National Institutes of Health outside the submitted work. No other disclosures were reported.
Conclusion and Next Steps
This study adds to the growing body of evidence on the impact of medication on aging populations, particularly concerning physical decline. As the global population continues to age, understanding and mitigating the effects of medications like anticholinergics will be crucial for public health. Clinicians are encouraged to incorporate these findings into their practice, potentially leading to revised guidelines for prescribing anticholinergic medications to older adults.
Future research should aim to include more diverse populations and explore alternative medications with fewer adverse effects on physical performance. As the healthcare community continues to prioritize healthy aging, studies like this play a vital role in shaping effective and safe treatment strategies for older adults.
