Anticholinergic medications associated with falls and frailty in people with HIV
Abstract
Background
Anticholinergic medications (ACMs) are associated with poorer age-related outcomes, including falls and frailty. We investigate associations between ACM use and recurrent falls and frailty among older (aged ≥50 years) people with HIV in the POPPY study.
Methods
Anticholinergic potential of co-medications at study entry was coded using the anticholinergic burden score, anticholinergic risk score, and Scottish Intercollegiate Guidelines Network score; drugs scoring ≥1 on any scale were defined as ACM. Associations with recurrent falls (two or more falls in the previous 28 days) and frailty (modified Fried's) were assessed using logistic regression adjusting for (1) possible demographic/lifestyle confounders and (2) clinical factors and depressive symptoms (Patient Health Questionnaire-9).
Results
ACM use was reported by 193 (28%) of 699 participants, with 64 (9%) receiving two or more ACM; commonly prescribed ACMs were codeine (12%), citalopram (12%), loperamide (9%), and amitriptyline (7%). Falls were reported in 63/673 (9%), and 126/609 (21%) met the frailty criteria. Both recurrent falls and frailty were more common in ACM users than in non-users (recurrent falls: 17% in users vs. 6% in non-users, p < 0.001; frailty: 32% vs. 17%, respectively, p < 0.001). Use of two or more ACMs was associated with increased odds of falls after adjustment for demographic/lifestyle factors (odds ratio [OR] 4.53; 95% confidence interval [CI] 2.06–9.98) and for clinical factors (OR 3.58; 95% CI 1.37–9.38). Similar albeit weaker associations were seen with frailty (OR 2.26; 95% CI 1.09–4.70 and OR 2.12; 95% CI 0.89–5.0, respectively).
Conclusions
ACM are commonly prescribed for people living with HIV, and evidence exists for an association with recurrent falls and frailty. Clinicians should be alert to this and reduce ACM exposure where possible.
CONFLICT OF INTEREST STATEMENT
Alan Winston has been an investigator on studies sponsored by and received research grants, speaker honoraria, or advisory board fees from ViiV Healthcare, Gilead Sciences, MSD, and Janssen. Jaime H. Vera has received travel and research grants from and has been speaker/advisor for Merck, Janssen Cilag, Piramal Imaging, ViiV Healthcare, and Gilead sciences. Frank A. Post has received grants and personal fees from Gilead Sciences, ViiV Healthcare, and MSD. MB has received speaker and advisor fees and/or research grants (to their organization) from GSK, ViiV, Pfizer, Roche, Novavax, Valneva, Moderna, Gilead, Mylan, Cipla, Janssen, MSD, and Atea. CS has received funding from Gilead Sciences, ViiV Healthcare, MSD, and Janssen-Cilag for membership of Advisory Boards and for preparation of educational materials. Jessica Doctor, Patrick W.G. Mallon, Jane Anderson, Christina Prechtl, Ian Williams, Margaret Johnson, Emmanouil Bagkeris, and Memory Sachikonye have no conflict of interests.
Open Research
DATA AVAILABILITY STATEMENT
Data available on request from the authors.
