Regularly using anticholinergics may double the risk of injurious falls in older men, according to a new analysis of the Irish Longitudinal Study on Ageing.

The study assessed injurious falls reported approximately two years after a baseline interview by 1,286 men and 1,410 women aged 65 years or older. At baseline, 4 per cent regularly used at least one medication with definite anticholinergic activity, usually antidepressants (e.g. paroxetine and amitriptyline), urological drugs (e.g. tolterodine) and antipsychotics. Thirty-seven per cent used drugs with possible anticholinergic activity, including furosemide, hydrochlorothiazide and atenolol.

Nine per cent of men and 17 per cent of women reported injurious falls. Men taking medications with definite anticholinergic activity at baseline were more than twice as likely to have injurious falls in the next two years (adjusted relative risk [RR] 2.55) than those taking other medicines. There was no change in the risk of having any fall or the number of falls.

No link emerged in women or with drugs
with possible anticholinergic activity. A dose-response relationship emerged between total anticholinergic burden and injurious falls. Findings (RR 2.53 for injurious falls) were similar using pharmacy dispensing records for a subset of 1,553 patients.

As the study used self-reports after two years, patients might have underreported falls. “Our findings indicate the importance for doctors, pharmacists and healthcare professionals to regularly review the appropriateness of medications taken by their older patients,” said lead researcher Dr Kathryn Richardson, from the school of health sciences at the University of East Anglia. “It is not fully clear why the same link was not found in women and further research is needed to explore this and the reasons behind the findings in men.” (J Am Geriatr Soc DOI: 10.1111/ jgs.13543)