Medications with strong anticholinergic burden, including some common psychiatric drugs, were tied to accelerated physical decline when used in older adults, suggesting these medications should be avoided in these patients, according to a study published today in JAMA Network Open.
Lower gait speed and grip strength are linked to poor health outcomes, such as new-onset disability and mortality, wrote Shelly L. Gray, Pharm.D., M.S., from the University of Washington in Seattle, and colleagues. “Drugs with anticholinergic and sedative properties are frequently prescribed to older adults, with prevalence ranging from 20% to 40%.... However, it is not known if long-term use has sustained associations with reduced physical function.”
Gray and colleagues looked at data from 4,283 adults 65 years or older without dementia at recruitment who attended at least two visits and had been enrolled for at least 10 years with Kaiser Permanente Washington. Researchers tallied participants’ exposure to medications deemed strong anticholinergics, including certain antipsychotics, sertraline and tricyclic antidepressants, benzodiazepines, and z-drugs. Researchers accounted for varying intensity, duration, and timing of past exposures to the medications to better estimate their cumulative effects and then correlated participants’ exposures to changes in their gait speed and grip strength.
Researchers found that higher cumulative anticholinergic exposure was associated with slightly larger decline rates in gait speed and grip strength beyond aging and comorbidities. Overall, their findings suggested that sustained high use of anticholinergics over several years could result in a gait speed decline that would reach the threshold of clinically meaningful.
Limitations of the study identified by the researchers included its predominantly White study population and the fact that prescribing guidance has recommended limiting anticholinergic use in older adults for several years. As a result, clinicians may have intentionally avoided these medications in older adults with multimorbidity and/or frailty—the group most likely to decline in physical performance—which could have minimized their findings.
“Anticholinergics are associated with numerous adverse outcomes in older adults; therefore, it is essential for clinicians to avoid their use when possible, prescribe the lowest effective dose, and periodically reevaluate patients to identify deprescribing opportunities to minimize potential harms,” researchers concluded.
For related information, see the Psychiatric News article “Anticholinergics Linked to Increased Risk of Dementia.”
(Image: Getty Images/iStock/Jacob Wackerhausen)
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