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Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study

Anticholinergic cognitive burden (ACB) may be associated with detrimental effects on mobility and physical independence in older adults. We evaluated the incidence of major mobility disability (MMD), persistent major mobility disability (PMMD), and injurious falls among participants within the Lifes...

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Autores principales: Squires, Patrick, Pahor, Marco, Manini, Todd M., Vouri, Scott, Brown, Joshua D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564216/
https://www.ncbi.nlm.nih.gov/pubmed/32947839
http://dx.doi.org/10.3390/jcm9092989
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author Squires, Patrick
Pahor, Marco
Manini, Todd M.
Vouri, Scott
Brown, Joshua D.
author_facet Squires, Patrick
Pahor, Marco
Manini, Todd M.
Vouri, Scott
Brown, Joshua D.
author_sort Squires, Patrick
collection PubMed
description Anticholinergic cognitive burden (ACB) may be associated with detrimental effects on mobility and physical independence in older adults. We evaluated the incidence of major mobility disability (MMD), persistent major mobility disability (PMMD), and injurious falls among participants within the Lifestyle Interventions for Elders (LIFE) trial according to varied anticholinergic burden levels. Participants aged 70–89 years were randomized to a physical activity (PA) or successful aging (SA) intervention and evaluated by ACB medication use as a summed score of a previously developed ACB scale. Confounders included demographic characteristics, physical function, cognitive function, and fall history. Average participant follow-up was 2.6 years and included outcome assessment for MMD, PMMD, and injurious falls every six months. Adjusted proportional hazards models evaluated the independent effects of ACB scores as well as interaction effects with the intervention. Of the 1635 participants, 986 (60%) used ≥1 anticholinergic medication. Compared to those with no burden, participants with an ACB score of 1 demonstrated increased MMD (HR = 1.42 [1.13–1.78]), PMMD (HR = 1.53 [1.12–2.09]), and injurious falls (HR = 1.60 [1.10–2.32]). Results similar in magnitude were observed for all other ACB levels versus the no burden group. Stepwise dose–response comparisons between ACB groupings did not demonstrate significant differences in outcomes. Stratification by PA or SA interventions demonstrated few differences from the combined overall trial results. Compared to those not taking anticholinergic medications, participants taking anticholinergic medications generally demonstrated increased risk of MMD, PMMD, and injurious falls. Total anticholinergic burden was not associated with a stepwise dose–response relationship in mobility disability and may lack sensitivity to capture varied responses.
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spelling pubmed-75642162020-10-26 Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study Squires, Patrick Pahor, Marco Manini, Todd M. Vouri, Scott Brown, Joshua D. J Clin Med Article Anticholinergic cognitive burden (ACB) may be associated with detrimental effects on mobility and physical independence in older adults. We evaluated the incidence of major mobility disability (MMD), persistent major mobility disability (PMMD), and injurious falls among participants within the Lifestyle Interventions for Elders (LIFE) trial according to varied anticholinergic burden levels. Participants aged 70–89 years were randomized to a physical activity (PA) or successful aging (SA) intervention and evaluated by ACB medication use as a summed score of a previously developed ACB scale. Confounders included demographic characteristics, physical function, cognitive function, and fall history. Average participant follow-up was 2.6 years and included outcome assessment for MMD, PMMD, and injurious falls every six months. Adjusted proportional hazards models evaluated the independent effects of ACB scores as well as interaction effects with the intervention. Of the 1635 participants, 986 (60%) used ≥1 anticholinergic medication. Compared to those with no burden, participants with an ACB score of 1 demonstrated increased MMD (HR = 1.42 [1.13–1.78]), PMMD (HR = 1.53 [1.12–2.09]), and injurious falls (HR = 1.60 [1.10–2.32]). Results similar in magnitude were observed for all other ACB levels versus the no burden group. Stepwise dose–response comparisons between ACB groupings did not demonstrate significant differences in outcomes. Stratification by PA or SA interventions demonstrated few differences from the combined overall trial results. Compared to those not taking anticholinergic medications, participants taking anticholinergic medications generally demonstrated increased risk of MMD, PMMD, and injurious falls. Total anticholinergic burden was not associated with a stepwise dose–response relationship in mobility disability and may lack sensitivity to capture varied responses. MDPI 2020-09-16 /pmc/articles/PMC7564216/ /pubmed/32947839 http://dx.doi.org/10.3390/jcm9092989 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Squires, Patrick
Pahor, Marco
Manini, Todd M.
Vouri, Scott
Brown, Joshua D.
Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study
title Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study
title_full Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study
title_fullStr Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study
title_full_unstemmed Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study
title_short Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study
title_sort impact of anticholinergic medication burden on mobility and falls in the lifestyle interventions for elders (life) study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564216/
https://www.ncbi.nlm.nih.gov/pubmed/32947839
http://dx.doi.org/10.3390/jcm9092989
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