Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study
Abstract
:1. Introduction
2. Methods
2.1. LIFE Study Overview
2.2. Interventions
2.3. Medication Use and Included Covariates
2.4. Follow-Up and Outcome Assessment
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
Score 1 | Score 2 | Score 3 |
---|---|---|
Alimemazine; n = 0 | Amantadine; n = 0 | Amitriptyline; n = 27 |
Alverine; n = 0 | Belladone alkaloids; n = 1 | Amoxapine; n = 0 |
Alprazolam; n = 39 | Carbamazepine; n = 4 | Atropine; n = 7 |
Atenolol; n = 201 | Cyclobenzaprine; n = 14 | Benztropine; n = 0 |
Bupropion; n = 24 | Cyproheptadine; n = 0 | Brompheniramine; n = 0 |
Captopril; n = 3 | Empracet; n = 0 | Carbinoxamine; n = 0 |
Chlorthalidone; n = 20 | Loxapine; n = 0 | Chlorpheniramine; n = 14 |
Cimetidine; n = 3 | Meperidine; n = 0 | Chlorpromazine; n = 0 |
Ranitidine; n = 57 | Methotrimeprazine; n = 0 | Clemastine; n = 0 |
Clorazepate; n = 1 | Molindone; n = 0 | Clomipramine; n = 0 |
Codeine; n = 11 | Oxcarbazepine; n = 4 | Clozapine; n = 0 |
Colchicine; n = 17 | Pethidine hydrochloride; n = 0 | Darifenacin; n = 10 |
Coumadin; n = 163 | Pimozide; n = 0 | Desipramine; n = 2 |
Diazepam; n = 8 | Dicyclomine; n = 3 | |
Digoxin; n = 57 | Dimenhydrinate; n = 0 | |
Dipyridamole; n = 4 | Diphenhydramine; n = 26 | |
Disopyramide; n = 1 | Doxepin; n = 1 | |
Fentanyl; n = 2 | Flavoxate; n = 0 | |
Furosemide; n = 173 | Hydroxyzine; n = 9 | |
Fluvoxamine; n = 0 | Hyoscyamine; n = 3 | |
Haloperidol; n = 1 | Imipramine; n = 6 | |
Hydralazine; n = 22 | Meclizine; n = 19 | |
Hydrocortisone; n = 13 | Nortriptyline; n = 4 | |
Isosorbide; n = 42 | Olanzapine; n = 1 | |
Loperamide; n = 28 | Orphenadrine; n = 0 | |
Metoprolol; n = 301 | Oxybutynin; n = 45 | |
Morphine; n = 3 | Paroxetine; n = 26 | |
Nifedipine; n = 40 | Perphenazine; n = 1 | |
Prednisone; n = 37 | Procyclidine; n = 0 | |
Quinidine; n = 2 | Promazine; n = 0 | |
Risperidone; n = 2 | Promethazine; n = 1 | |
Theophylline; n = 4 | Propantheline; n = 0 | |
Trazodone; n = 26 | Pyrilamine; n = 0 | |
Triamterene; n = 72 | Tolterodine; n = 28 | |
Quetiapine; n = 2 |
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Characteristics | Summed Total Anticholinergic Burden Score | p-Value | ||||
---|---|---|---|---|---|---|
ACB Score = 0 n = 644 (39.5%) | ACB Score = 1 n = 463 (28.4%) | ACB Score = 2 n = 199 (12.2%) | ACB Score = 3 n = 156 (9.6%) | ACB Score = 4+ n = 168 (10.3%) | ||
Age, Mean (SD) | 78.7 (5.2) | 79.2 (5.0) | 78.9 (5.5) | 78.8 (5.2) | 78.9 (5.4) | 0.6440 |
Female | 446 (69.3%) | 298 (64.4%) | 123 (61.8%) | 100 (64.1%) | 127 (75.6%) | 0.0208 |
Race | ||||||
White | 499 (77.5%) | 335 (72.4%) | 148 (74.4%) | 123 (78.9%) | 137 (81.6%) | 0.1831 |
Black | 105 (16.3%) | 98 (21.2%) | 40 (20.1%) | 21 (13.5%) | 21 (12.5%) | |
Other | 40 (6.2%) | 30 (6.5%) | 11 (5.3%) | 12 (7.7%) | 10 (6.0%) | |
Education, ≥High School | 434 (67.4%) | 289 (62.4%) | 125 (62.8%) | 99 (63.5%) | 100 (59.5%) | 0.2583 |
Systolic Blood Pressure, Mean (SD) | 127.2 (17.5) | 127.7 (19.0) | 129.0 (18.1) | 125.6 (18.0) | 127.7 (16.4) | 0.4832 |
Diastolic Blood Pressure, Mean (SD) | 68.6 (10.0) | 67.5 (10.6) | 68.6 (9.8) | 68.1 (10.2) | 68.2 (10.2) | 0.4007 |
Smoking Status | ||||||
Never | 343 (53.3%) | 242 (52.3%) | 109 (54.8%) | 78 (50.0%) | 88 (52.4%) | 0.9125 |
Former | 279 (43.3%) | 205 (44.3%) | 86 (43.2%) | 74 (47.4%) | 77 (45.8%) | |
Current | 22 (3.4%) | 16 (3.5%) | 4 (2.0%) | 4 (2.6%) | 3 (1.8%) | |
Body Mass Index (SD) | 29.7 (5.7) | 30.2 (5.9) | 30.9 (6.3) | 31.0 (6.4) | 30.5 (6.4) | 0.0517 |
Average Waist Circumference in cm (SD) | 100.8 (15.6) | 101.9 (15.2) | 104.0 (15.2) | 103.6 (15.0) | 101.0 (16.0) | 0.0624 |
Hypertension | 378 (58.7%) | 358 (77.3%) | 165 (82.9%) | 111 (71.2%) | 139 (82.7%) | <0.0001 |
Stroke | 41 (6.4%) | 33 (7.1%) | 19 (9.6%) | 6 (3.9%) | 10 (6.0%) | 0.2850 |
Diabetes | 138 (21.4%) | 117 (25.3%) | 61 (30.7%) | 43 (27.6%) | 56 (33.3%) | 0.0067 |
Heart Attack | 25 (3.9%) | 44 (9.5%) | 30 (15.1%) | 8 (5.1%) | 22 (13.1%) | <0.0001 |
Heart Failure | 9 (1.4%) | 19 (4.1%) | 12 (6.0%) | 11 (7.1%) | 20 (11.9%) | <0.0001 |
Arthritis | 114 (17.7%) | 89 (19.2%) | 45 (22.6%) | 31 (19.9%) | 39 (23.2%) | 0.3971 |
Chronic Lung Disease | 88 (13.7%) | 63 (13.6%) | 37 (18.6%) | 32 (20.5%) | 33 (19.6%) | 0.0573 |
Cancer | 125 (19.4%) | 113 (24.4%) | 42 (21.1%) | 42 (11.4%) | 48 (13.0%) | 0.0419 |
SPPB ≤ 7 | 379 (58.9%) | 255 (55.1%) | 110 (55.3%) | 78 (50.0%) | 79 (47.0%) | 0.0454 |
Self-Rated Overall Health | ||||||
Poor | 7 (1.1%) | 7 (1.5%) | 2 (1.0%) | 0 (0.0%) | 4 (2.4%) | <0.0001 |
Fair | 79 (12.3%) | 71 (15.3%) | 36 (18.1%) | 31 (19.9%) | 34 (20.2%) | |
Good | 276 (42.9%) | 240 (51.8%) | 114 (57.3%) | 78 (50.0%) | 87 (51.8%) | |
Very Good | 228 (35.4%) | 119 (25.7%) | 38 (19.1%) | 41 (9.0%) | 36 (21.4%) | |
Excellent | 54 (8.4%) | 26 (5.6%) | 9 (4.5%) | 6 (3.9%) | 7 (4.2%) | |
Moderate Activity (Daily Average), Mean (SD) | ||||||
Minutes | 32 (28) | 24 (21) | 26 (22) | 25 (20) | 21 (15) | <0.0001 |
Steps | 1162 (1245) | 869 (920) | 975 (1116) | 797 (833) | 720 (752) | <0.0001 |
400 Meter Gait Speed (meters/second), Mean (SD) | 0.77 (0.16) | 0.76 (0.16) | 0.78 (0.17) | 0.74 (0.14) | 0.74 (0.16) | 0.0230 |
Cognitive Assessment (3MSE), Mean (SD) | 92.0 (5.3) | 91.4 (5.4) | 91.1 (5.7) | 91.5 (5.8) | 91.5 (5.3) | 0.1872 |
Overall Number of Medications, Mean (SD) | 7.6 (3.9) | 9.1 (3.8) | 10.9 (3.9) | 10.5 (4.3) | 13.3 (4.8) | <0.0001 |
Number of ACB Medications, Mean (SD) | 0 (0) | 1 (0) | 1.97 (0.2) | 1.8 (1.0) | 3.0 (1.0) | <0.0001 |
Experienced Dizziness in Past 6 Months | 137 (21.3%) | 76 (16.4%) | 48 (24.1%) | 32 (20.5%) | 50 (29.8%) | 0.0051 |
Experienced Fall in Past Year | 317 (49.2%) | 213 (46.0%) | 95 (47.7%) | 93 (59.6%) | 98 (58.3%) | 0.0074 |
Experienced Fall Requiring Medical Attention (Past Year) | 74 (11.5%) | 53 (11.5%) | 25 (12.6%) | 16 (10.3%) | 21 (12.5%) | 0.9625 |
Physical Activity | Successful Aging | |||||
---|---|---|---|---|---|---|
Outcome | Events, n | Person-Years (PY) | Events/100 PY | Events, n | Person-Years (PY) | Events/100 PY |
MMD | ||||||
ACB score = 0 | 78 | 759.80 | 10.26 | 87 | 724.66 | 12.01 |
ACB score = 1 | 73 | 494.3 | 14.77 * | 88 | 519.2 | 16.95 * |
ACB score = 2 | 33 | 216.99 | 15.21 | 43 | 208.39 | 20.63 * |
ACB score = 3 | 25 | 174.7 | 14.31 | 37 | 138.79 | 26.66 *,† |
ACB score= 4+ | 36 | 176.4 | 20.41 * | 35 | 178.84 | 19.57 * |
pMMD | ||||||
ACB score = 0 | 36 | 782.03 | 4.60 | 46 | 754.38 | 6.10 |
ACB score = 1 | 39 | 510.83 | 7.63 * | 49 | 534.9 | 9.16 * |
ACB score = 2 | 16 | 212.26 | 7.54 | 32 | 216.03 | 14.81 *,† |
ACB score = 3 | 12 | 183.62 | 6.54 | 24 | 144.37 | 16.62 *,† |
ACB score = 4+ | 21 | 186.99 | 11.23 * | 18 | 180.89 | 9.95 |
Injurious Falls | ||||||
ACB score = 0 | 27 | 831.84 | 3.25 | 33 | 801.41 | 4.12 |
ACB score = 1 | 31 | 555.16 | 5.58 * | 31 | 601.38 | 5.15 |
ACB score = 2 | 12 | 237.07 | 5.06 | 14 | 260.16 | 5.38 |
ACB score = 3 | 9 | 200.22 | 4.50 | 9 | 181.93 | 4.95 |
ACB score = 4+ | 16 | 209.72 | 7.63 * | 15 | 206.53 | 7.26 * |
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Squires, P.; Pahor, M.; Manini, T.M.; Vouri, S.; Brown, J.D. Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study. J. Clin. Med. 2020, 9, 2989. https://doi.org/10.3390/jcm9092989
Squires P, Pahor M, Manini TM, Vouri S, Brown JD. Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study. Journal of Clinical Medicine. 2020; 9(9):2989. https://doi.org/10.3390/jcm9092989
Chicago/Turabian StyleSquires, Patrick, Marco Pahor, Todd M. Manini, Scott Vouri, and Joshua D. Brown. 2020. "Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study" Journal of Clinical Medicine 9, no. 9: 2989. https://doi.org/10.3390/jcm9092989