Table 2.
Summary of results for studies reporting impact of ACB upon falls (n = 8).
| Study | ACB baseline | Follow-up duration (months) | Falls measure and source | Results (adjusted) ⩽12 months | Results (adjusted) ⩾24 months | ||
|---|---|---|---|---|---|---|---|
| ACBS | |||||||
| Green et al. 14 | ACBS (mean, SD) | 1.1 (1.43) | 12 | Any fall or fall-related injury recorded in medical records and/or insurance claims | HR (95% CI)a,b | ||
| +ACB1 1.11 (0.99–1.23) | |||||||
| +ACB2 1.56 (1.16–2.10) | |||||||
| +ACB3 1.08 (0.97–1.20) | |||||||
| Richardson et al. 17 | ACBS = 0 (n): | 1577 | 24 | Injurious falls recorded in insurance claims | Male RR (95% CI) c | Female RR (95% CI) | |
| ACBS = 1 (n): | 663 | ACBS 1: 1.44 (0.89–2.33) | 0.77 (0.56–1.05) | ||||
| ACBS = 2 (n): | 248 | ACBS 2: 1.33 (0.68–2.60) | 0.89 (0.60–1.33) | ||||
| ACBS = 3 (n): | 110 | ACBS 3: 0.74 (0.25–2.21) | 0.75 (0.41–1.37) | ||||
| ACBS = 4 (n): | 50 | ACBS 4: 2.19 (0.71–6.75) | 1.02 (0.54–1.93) | ||||
| ACBS = ⩾5 (n): | 48 | ACBS ⩾5: 4.95 (2.11–11.65) | 1.03 (0.53–2.03) | ||||
| Squires et al. 18 | 30 d | Injurious fall (hospitalised) recorded in medical records | HR (95% CI) e | ||||
| ACBS = 1 (n): | 463 | ACBS 1: 1.60 (1.10–2.32) | |||||
| ACBS = 2 (n): | 199 | ACBS 2: 1.67 (1.02–2.74) | |||||
| ACBS = 3 (n): | 156 | ACBS 3: 1.23 (0.71–2.14) | |||||
| ACBS = ⩾4 (n): | 168 | ACBS ⩾4: 1.86 (1.13–3.07) | |||||
| Suehs et al. 19 | ACBS ⩾2 | 48.0% | 38.5 f | Fall or fracture recorded from insurance claims | HR (95% CI) g | ||
| Current use: 1.28 (1.23–1.32) | |||||||
| Past use: 1.14 (1.11–1.17) | |||||||
| Intensity of Ach Exposure | |||||||
| Low 1.04 (1.00–1.07) | |||||||
| Moderate 1.13 (1.09–1.17) | |||||||
| High 1.31 (1.26–1.36) | |||||||
| Tan et al. 20 | ACBS (mean, SD): | 2.42 (1.95) | 24 | Falls resulting in hospitalisation recorded in medical records | HR (95% CI) h | ||
| ACBS 1: 0.94 (0.31–2.81) | |||||||
| ACBS 2–3: 1.80 (0.59–5.47) | |||||||
| ACBS ⩾4: 4.34 (1.67–11.27) | |||||||
| Zia et al. 21 | ACBS ⩾1: | 12 | At least two falls or one injurious fall recorded in medical records | OR (95%CI) i | |||
| Cases (n): | 75 | ACBS ⩾1 1.8 (1.1–3.0) | |||||
| Controls (n): | 29 | ||||||
| ARS | |||||||
| Hwan et al. 15 | ARS | NR | 3 | ED visit for fall or fracture recorded in ED medical records | HR (95% CI) j | ||
| ARS ⩾2: 1.31 (1.07–1.60) | |||||||
| Landi et al. 16 | ARS = >1 (n) | 721 | 12 | Any episode of a fall during follow up recorded from medical records and patient interviews | OR (95% CI) k | ||
| ARS >1 1.26 (1.13–1.41) | |||||||
Analysis presented in relation to each additional class 1, 2 or 3 medication and not ACB score.
Adjusted for age, sex, combined number of ambulatory, ED and inpatient visits, atrial fibrillation, rheumatoid arthritis/osteoarthritis, epilepsy, Parkinson’s disease, neuropathy, vertigo, depression and mild cognitive impairment/dementia status.
Adjusted for age, living status, education, employment status, income, smoking status, alcoholism, time between interviews, each comorbidity, incontinence, pain, sleep problems, depressive symptoms, cognition, self-rated vision, self-rated hearing, disability, history of falls, fracture, fainting, hospitalisation and the number of other nonanticholinergic antihypertensive, diuretic, antipsychotic, sedative and hypnotic, antidepressant and other medications.
Mean, SD not reported.
Adjusted for age, sex, race, education, systolic blood pressure, diastolic blood pressure, smoking status, body mass index, waist circumference, history of hypertension, history of stroke, history of diabetes, history of heart attack, history of heart failure, history of arthritis, history of chronic lung disease, history of cancer, short physical performance battery, self-rated overall health, activity levels, 400 m gait speed, cognitive assessment, overall number of medications, number of anticholinergic medications, patient experienced dizziness in past 6 months, patient experienced a fall in the past year, patient experienced a fall requiring medical attention in the past year.
Mean, SD not reported.
Adjusted for age, sex, race, baseline count of unique medications, baseline Elixhauser conditions and time-varying exposure to nonanticholinergic medications associated with fall risk.
Adjusted for age, gender, physical activity, myocardial infarction, stroke, diabetes, asthma or chronic obstructive pulmonary disease, antidepressants and systolic blood pressure.
Unadjusted data only.
Adjusted for age, gender, insurance type, comorbid conditions, polypharmacy, excessive polypharmacy, exposure to sedative drugs, warfarin, insulin and digoxin.
Adjusted for age, gender, comorbidity, baseline physical and cognitive function scores, schizophrenia, depression and cognitive performance.
ACB, anticholinergic burden; ACBS, anticholinergic cognitive burden scale; ARS, anticholinergic risk score; CI, confidence interval; ED, emergency department; HR, hazard ratio; NR, not reported; OR, odds ratio; RR, risk ratio; SD, standard deviation.