Anticholinergic Burden and Falls in Older Adults: The Role of Functional Status
- 1Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale 17000, Türkiye
- 2Department of Emergency Medicine, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale 17000, Türkiye
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.
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BibTeX
@article{mutlay2026anticholinergic,
title = {{Anticholinergic Burden and Falls in Older Adults: The Role of Functional Status}},
author = {Feyza Mutlay and Murat Das},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207811},
url = {https://www.mdpi.com/2077-0383/15/20/7811},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Anticholinergic Burden and Falls in Older Adults: The Role of Functional Status
AU - Feyza Mutlay
AU - Murat Das
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207811
UR - https://www.mdpi.com/2077-0383/15/20/7811
AB - 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.
SN - 2077-0383
ER -